Extended HPV Genotyping for Risk Assessment of Cervical Intraepithelial Neoplasia Grade 2/3 or Worse in a Cohort Study
Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases of Zhejiang Province;
Cancer Research Institute of Zhejiang University; and
Search for other papers by Xiao Li in
Current site
Google Scholar
PubMed
Search for other papers by Xuan Rao in
Current site
Google Scholar
PubMed
Search for other papers by Ming-Jing Wei in
Current site
Google Scholar
PubMed
Cancer Research Institute of Zhejiang University; and
Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, Zhejiang, China.
Search for other papers by Wei-Guo Lu in
Current site
Google Scholar
PubMed
Search for other papers by Xing Xie in
Current site
Google Scholar
PubMed
Cancer Research Institute of Zhejiang University; and
Search for other papers by Xin-Yu Wang in
Current site
Google Scholar
PubMed
Background: We sought to identify the absolute risk of specific HPV genotype for cervical intraepithelial neoplasia grade 2/3 or worse (CIN2+/3+) and to develop a risk-based management strategy in an HPV-positive population. Methods: HPV genotyping was performed based on a 3-year cervical cancer screening cohort. The study endpoints were histologic CIN2+/3+. The prevalence of specific HPV genotype was calculated by minimum, any type, and hierarchical attribution estimate. The absolute CIN2+/3+ risks of specific HPV genotype were estimated and risk-based management strategy was established according to the American Society for Colposcopy and Cervical Pathology guideline. The efficacy of conventional and risk-based management strategies for non-16/18 HPVs were further evaluated. Results: Eligible data were available for 8,370 women with a median age of 48 years (interquartile range, 42–53 years). At baseline, there were 1,062 women with HPV-positive disease, including 424 with multiple and 639 with single infections. CIN2+/3+ cases represented 113/74, 23/8, 20/7, and 52/31 patients at baseline and first-, second-, and third-year visits, respectively. Women with multiple HPV infections at baseline were more prone to persistent infection than those with single infection (P<.0001). HPV16 and HPV52 were the top 2 ranking among baseline and 3-year cumulative CIN2+/3+ cases. Based on the absolute risk of specific HPV genotype combined with cytology for CIN2+/3+, all non-16/18 HPVs were divided into 4 risk-stratified groups. Compared with conventional strategy, the risk-based strategy had higher specificity (P=.0000) and positive predictive value (P=.0322) to detect CIN3+ and needed fewer colposcopies for each CIN3+ case. Conclusions: Based on our study findings, we propose a new extended HPV genotyping protocol, which would provide a better strategy for achieving precise risk-based management of HPV-positive populations.
Submitted December 14, 2021; final revision received April 25, 2022; accepted for publication May 10, 2022.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Author contributions: Conceptualization: Li, Wang. Data curation: Li, Rao, Wei. Formal analysis: Li, Rao. Software: Rao, Wei. Methodology: Rao. Supervision: Lu, Xie, Wang. Validation: All authors. Writing—original draft: Li, Rao, Wei. Writing—review and editing: Li, Lu, Xie, Wang.
Funding: This study was supported by National Key R&D Program of China (grant number, 2021YFC2701204) and the Key Research and Development Program of Zhejiang province, China (grant number, 2020C03025).
Supplementary Materials
- Supplemental Materials (PDF 552 KB)
© 2019-2024 National Comprehensive Cancer Network