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      Distribution and role of high‐risk human papillomavirus genotypes in women with cervical intraepithelial neoplasia: A retrospective analysis from Wenzhou, southeast China

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          Abstract

          To add the growing literature on baseline of high‐risk human papillomavirus ( HRHPV) genotype distribution in cervical intraepithelial neoplasia ( CIN) before the widespread using of HPV vaccines in Chinese mainland and to improve risk stratification of HRHPV–positive women. Retrospectively, the data of age, cervical HPV genotypes, cytology, and pathology were collected from 1166 patients who received loop electrosurgical excision procedure ( LEEP). HPV genotypes were analyzed with Flowcytometry Fluorescence Hybridization Method. And then HPV prevalence, HRHPV genotype distribution and the correlation of HRHPV genotypes with CIN2+ ( CIN2 or severer) were analyzed. The role of multiple HRHPV types infection with or without HPV16/18 in the pathogenesis of CIN2+ was also analyzed. The 6 most common HRHPV genotypes were HPV16, 58, 52, 33, 18, and 31 in descending order. Compared to HRHPV–negative women, HPV16, 33 or 58 positive women had higher risk of CIN2+ ( OR = 5.10, 95% CI = 2.68‐9.70; OR = 3.09, 95% CI = 1.39‐6.84; OR = 3.57, 95% CI = 1.85‐6.89, respectively). And women who were infected by multiple HRHPV types infection with HPV16/18 also had higher risk of CIN2+ ( OR = 2.58, 95% CI = 1.35‐4.92). However, multiple HRHPV types infection without HPV16/18 did not increase the risk significantly ( P = .08). Compare to bivalent Cervarix ® and quadrivalent Gardasil ®, HPV prophylactic vaccine targeting HPV31, 33, 52, and 58 might provide women more protection from HPV‐induced cervical cancer in China. The women who infected by HPV16, 33, 58, or multiple HRHPV types with HPV16/18 have higher risk of CIN2+ and need to be paid more attention in screening processes. And the role of multiple HRHPV types infection without HPV16/18 needs be further identified in more studies.

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          Most cited references28

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          American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.

          An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
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            Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease.

            We investigated coinfection patterns for 25 human papillomavirus (HPV) types and assessed the risk conferred by multiple HPV types toward cervical disease. Sexually active women (n=5,871) in the NCI-sponsored Costa Rica HPV Vaccine Trial's prevaccination enrollment visit were analyzed. Genotyping for 25 HPVs was performed using SPF(10)/LiPA(25). We calculated odds ratios (ORs) to assess coinfection patterns for each genotype with 24 other genotypes. These ORs were pooled and compared with pair-specific ORs to identify genotype combinations that deviated from the pooled OR. We compared risk of CIN2+/HSIL+between multiple and single infections and assessed additive statistical interactions. Of the 2478 HPV-positive women, 1070 (43.2%) were infected with multiple types. Multiple infections occurred significantly more frequently than predicted by chance. However, this affinity to be involved in a coinfection (pooled OR for 300 type-type combinations=2.2; 95% confidence interval [CI]=2.1-2.4) was not different across HPV type-type combinations. Compared with single infections, coinfection with multiple α9 species was associated with significantly increased risk of CIN2+(OR=2.2; 95% CI=1.1-4.6) and HSIL+(OR=1.6; 95% CI=1.1-2.4). However, disease risk was similar to the sum of estimated risk from individual types, with little evidence for synergistic interactions. Coinfecting HPV genotypes occur at random and lead to cervical disease independently.
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              Human papillomavirus genotype attribution for HPVs 6, 11, 16, 18, 31, 33, 45, 52 and 58 in female anogenital lesions.

              Human papillomavirus (HPV) vaccines can potentially control cervical cancer and help to reduce other HPV-related cancers. We aimed to estimate the relative contribution (RC) of the nine types (HPVs 16/18/31/33/45/52/58/6/11) included in the recently approved 9-valent HPV vaccine in female anogenital cancers and precancerous lesions (cervix, vulva, vagina and anus).
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                Author and article information

                Contributors
                drhuyan@wzhospital.cn
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                30 May 2018
                July 2018
                : 7
                : 7 ( doiID: 10.1002/cam4.2018.7.issue-7 )
                : 3492-3500
                Affiliations
                [ 1 ] Department of Gynecology The 1st Affiliated Hospital Wenzhou Medical University Wenzhou China
                Author notes
                [*] [* ] Correspondence

                Yan Hu, Department of Gynecology, The 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.

                Email: drhuyan@ 123456wzhospital.cn

                Author information
                http://orcid.org/0000-0001-8428-4204
                http://orcid.org/0000-0003-1381-8920
                Article
                CAM41559
                10.1002/cam4.1559
                6051158
                29851256
                e02b17d7-252a-4d1d-a27d-e8f2dc0d9b73
                © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 November 2017
                : 16 April 2018
                : 19 April 2018
                Page count
                Figures: 1, Tables: 4, Pages: 9, Words: 6167
                Funding
                Funded by: Wenzhou Science and Technology Bureau, China
                Award ID: Y20170132
                Categories
                Original Research
                Cancer Prevention
                Original Research
                Custom metadata
                2.0
                cam41559
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.3 mode:remove_FC converted:18.07.2018

                Oncology & Radiotherapy
                association,cervical intraepithelial neoplasia,genotype distribution,human papillomavirus

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