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Type: Artigo de periódico
Title: Persistent High-Risk Human Papillomavirus Infections and Other End-Point Markers of Progressive Cervical Disease Among Women Prospectively Followed up in the New Independent States of the Former Soviet Union and the Latin American Screening Study Cohorts
Author: Syrjanen, K
Shabalova, I
Naud, P
Kozachenko, V
Derchain, S
Zakharchenko, S
Roteli-Martins, C
Nerovjna, R
Longatto, A
Kljukina, L
Tatti, S
Branovskaja, M
Hammes, LS
Branca, M
Grunjberga, V
Erzen, M
Sarian, LO
Juschenko, A
Costa, S
Podistov, J
Syrjanen, S
Abstract: Background: New end points are needed in future human papillomavirus (HPV) vaccine efficacy studies that accurately predict disease progression. Objectives: Potential intermediate end points were analyzed in the combined New Independent States of the Former Soviet Union (NIS) and the Latin American Screening (LAMS) study cohorts. Study Design and Methods: Data files of 2 international screening trials, the NIS (n = 3187) and the LAMS (n = 12,114) study cohorts, were combined, and a subcohort of 1865 (n = 854 and n 10 11 for the NIS and the LAMS, respectively) women prospectively followed up for 19.7 (median, 22.2) months was analyzed for different intermediate end-point markers of disease progression to squamous intraepithelial lesion (SIL), cervical intraepithelial neoplasia grade I and higher (CIN1+), and CIN grade 2 and higher (CIN2+) as terminal events. Results: Altogether, 131 (7.0%), 90 (4.8%), and 39 (2.1%) cases progressed to SIL, CIN 1+, and CIN2+, respectively, progression times being equal in the NIS (11.9, 16.8, and 19.6 months) and LAMS (13.6, 14.1, and 15.4 months) cohorts (P = 0.931, P = 0.335, and P = 0.535). The 2 most powerful end-point markers of disease progression to CIN2+ were high-grade squamous intraepithelial lesions based on Papanicolaou test results at 6-month (odds ratio [OR] = 47.1; 95% confidence interval [Cl], 17.3-128.7) and 12-tilonth (OR = 21.5; 95% CI, 5.1-90.8) follow-up Visits, With longitudinal positive and negative predictive values of 42.1% and 98.0% (6 months) and 33.3% and 97.7% (12 months). Of the virological end points, more than 6 months of persistent high-risk HPV (HR-HPV) was the most powerful predictor of progression to CIN1+ (OR = 18.6; 95% CI, 2.5-136.5), with longitudinal positive and negative predictive values of 10.3% and 99.4%, respectively. No additional benefit was obtained using more than 12 months of persistent HR-HPV end point. Conclusions: High-grade squamous intraepithelial lesion based on a Papanicolaou test results at 6- or 12-month follow-up Visits was the most powerful end point, either considering cytological end points alone or in comparison to any of the virological end points. Of the virological end points, more than 6-month HR-HPV persistence criteria give the most powerful estimate of a progressive disease.
Subject: HPV
Cervical infections
Prospective follow-up
Intermediate end points
NIS cohort
LAMS study
Country: EUA
Editor: Lippincott Williams & Wilkins
Citation: International Journal Of Gynecological Cancer. Lippincott Williams & Wilkins, v. 19, n. 5, n. 934, n. 942, 2009.
Rights: fechado
Identifier DOI: 10.1111/IGC.0b013e3181a834fe
Date Issue: 2009
Appears in Collections:Unicamp - Artigos e Outros Documentos

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