J Gynecol Oncol.  2019 May;30(3):e50. 10.3802/jgo.2019.30.e50.

Risk of cervical dysplasia among human papillomavirus-infected women in Korea: a multicenter prospective study

• Park Y
• Kim TJ
• Hwang CS
• Cho CH
• Jeong DH
• Seong SJ
• Lee JK
• Hur S
• Kee MK
• Seong J
• Ki M

• KMID: 2440510
• DOI: http://doi.org/10.3802/jgo.2019.30.e50

Abstract

OBJECTIVE
Human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, which progresses from precursor lesions with no symptom if left untreated. We compared the risk of cervical dysplasia among HPV-positive Korean women based on HPV types and infection patterns.
METHODS
We observed participants of a 5-year multicenter prospective cohort study, comprising HPV-positive women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion of the cervix at their enrollment. Follow-ups, comprising cytology and HPV DNA testing results, were included in the final analysis. Incidence was calculated for each infection pattern (persistent infection, incidental infection, and clearance). To investigate cervical dysplasia risk, we used Cox proportional hazard models adjusted for variables that were significantly different among infection patterns. From April 2010 to September 2017, 71 of 1,027 subjects developed cervical dysplasia more severe than high-grade squamous intraepithelial lesion of the cervix.
RESULTS
Of these 71 subjects, persistent infection, incidental infection, and clearance were noted in 30, 39, and 2 individuals, respectively. Based on changes in DNA results during follow-up, cumulative incidence was 27.2%, 10.4%, and 0.5% for persistent infection, incidental infection, and clearance, respectively. Compared to clearance, the adjusted hazard ratios for cervical dysplasia were 51.6 and 24.1 for persistent and incidental infections, respectively (p < 0.001).
CONCLUSION
Individuals persistently infected with the same HPV types during the follow-up period had the highest risk of severe cervical dysplasia. Hence, it is necessary to monitor HPV types and infection patterns to prevent severe cervical precancerous lesions.

Keyword

Papillomavirus Infections; Uterine Cervical Cancer; Uterine Cervical Dysplasia; Cohort Studies; Republic of Korea

MeSH Terms

Atypical Squamous Cells of the Cervix
Cervix Uteri
Cohort Studies
DNA
Female
Follow-Up Studies
Human Papillomavirus DNA Tests
Humans*
Incidence
Korea*
Papillomavirus Infections
Proportional Hazards Models
Prospective Studies*
Republic of Korea
Risk Factors
Squamous Intraepithelial Lesions of the Cervix
Uterine Cervical Dysplasia
Uterine Cervical Neoplasms
DNA

Figure

• 

  Fig. 1. Examples of infection patterns and their definitions. The symbols (eg. diamond, square, or circle) stand for different HPV genotype detected at the time of visit, and the notation of (−) stands for being negative without detecting any of HPV genotype. HPV, human papillomavirus.

• 

  Fig. 2. Distribution of HPVs among ASCUS or LSIL cases. ASCUS, atypical squamous cells of undetermined significance; HPV, human papillomavirus; LSIL, low-grade squamous intraepithelial lesion. * Detailed percentages of high-risk HPVs: HPV-16 (9.8%), HPV-58 (8.7%), HPV-56 (7.8%), HPV-53 (7.7%), HPV-52 (6.5%), HPV-39 (5.6%), HPV-68 (5.3%), HPV-51 (4.9%), HPV-18 (4.4%), HPV-66 (4.1%), HPV-35 (2.5%), HPV-31 (2.3%), HPV-33 (2.0%), HPV-59 (2.0%), HPV-45 (1.5%), HPV-82 (0.6%), HPV-69 (0.3%), HPV-26 (0.2%), and HPV-73 (0.1%).

• 

  Fig. 3. Cumulative incidence of cervical dysplasia based on HPV infection patterns during follow-up in the Korea HPV cohort, 2010–2017. HPV, human papillomavirus.

Reference

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