Atypical glandular cells and development of cervical cancer: Population-based cohort study.

Autor: Norman I; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden., Yilmaz E; Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden., Hjerpe A; Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden., Hortlund M; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.; LINK Medical Research AB, Malmö, Sweden., Elfström KM; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden., Dillner J; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: International journal of cancer [Int J Cancer] 2022 Dec 01; Vol. 151 (11), pp. 2012-2019. Date of Electronic Publication: 2022 Aug 27.
DOI: 10.1002/ijc.34242
Abstrakt: The effect of cervical screening on cervical adenocarcinoma has been variable, possibly because the risk associated with the precursor atypical glandular cells (AGC) is not well known. A cohort of all 885 women in the capital region of Sweden with AGC, a concomitant human papillomavirus (HPV) analysis, and a histopathology was followed until 2019. Cumulative incidence proportions of cervical intraepithelial lesion grade 3 or worse (CIN3+) by HPV type was determined by 1-Kaplan-Meier estimates. Hazard ratios (HR) for CIN3+ or for invasive cancer were estimated with Cox regression. After 2 years of follow-up, the cumulative incidence proportions of CIN3+ were 80% (95% confidence interval [CI]: 74-86%), 58% (95% CI: 50-60%) and 10% (95% CI: 5-18%) among HPV16/18 positive, "other HPV" positive and HPV-negative women, respectively. Among the 300 women with HPV16/18 positive AGC, 217 developed CIN3+ of which 35 were invasive cervical cancer. The 2-year cumulative invasive cancer risk for HPV16/18 positive AGC was 17% (95% CI: 12-24%). Primary HPV-screening had a similar yield of CIN3+ as cytology screening, albeit HPV-negative AGC is by design not detected by HPV screening. Among 241 women with HPV-negative AGC, 11 developed CIN3+ mostly after clinically indicated samples. We found no significant risk differences depending on age or sampling indication. The low CIN3+ risk after HPV-negative AGC implies safety of primary HPV screening. The high risk of invasive cervical cancer after HPV16/18 positive AGC implies that management of this finding is a priority in cervical screening.
(© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)
Databáze: MEDLINE
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