Comparative Analysis of Cervical Cancer Screening Results in 2019 and 2020 in Shihezi Urban Areas, Xinjiang

doi:10.12114/j.issn.1007-9572.2022.02.007

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (18): 2223-2230.DOI: 10.12114/j.issn.1007-9572.2022.02.007

Special Issue: 肿瘤最新文章合集

• Article·Cervical Cancer Study • Previous Articles Next Articles

Comparative Analysis of Cervical Cancer Screening Results in 2019 and 2020 in Shihezi Urban Areas, Xinjiang

Department of Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University/National Health Commission Key Laboratory of Prevention and Treatment of High Incidence Diseases in Central Asia, Shihezi 832008, China

Received:2021-12-10 Revised:2022-01-10 Published:2022-06-20 Online:2022-01-20
Contact: Ping YANG
About author:
LIU Y, WEI Y, YANG P. Comparative analysis of cervical cancer screening results in 2019 and 2020 in Shihezi urban areas, Xinjiang[J]. Chinese General Practice, 2022, 25 (18) : 2223-2230.

2019年和2020年新疆石河子城区宫颈癌筛查结果对比研究

832008　新疆维吾尔自治区石河子市，石河子大学医学院第一附属医院妇科　国家卫生健康委中亚高发病防治重点实验室

通讯作者: 杨萍
作者简介:
刘玉，韦艳，杨萍. 2019年和2020年新疆石河子城区宫颈癌筛查结果对比研究[J].中国全科医学，2022，25（18）：2223-2230. [www.chinagp.net] 作者贡献：刘玉提出研究思路，设计研究方案，进行统计学分析，负责结果的分析与解释，撰写论文初稿；刘玉、杨萍进行研究的实施与可行性分析；刘玉、韦艳进行数据收集、采集、清洗、绘制图表等，数据整理；杨萍进行论文的修订，负责文章的质量控制及审校，对文章整体负责，监督管理。所有作者确认论文终稿。
基金资助:
国家自然科学基金面上项目(82072893); 石河子大学成果转化与技术推广计划(CGZH201701); 中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2020-PT330-003); 兵团科技攻关项目(2017DB012)

Abstract

Abstract:

Background

The results of cervical cancer containment have demonstrated regional differences in China, which may be due to various socioeconomic and cultural developments across regions. Understanding cervical cancer screening results in various regions is of a great significance for developing effective cervical cancer prevention strategies.

Objective

To perform a comparative analysis of the results of two yearly cervical cancer screening (2019 and 2020) in urban areas of Shihezi, Xinjiang, to estimate the changes in high-risk human papillomavirus (hrHPV) infection and cervical lesion detection rate in women.

Methods

A retrospective design was used. Participants were 46 994 women from Shihezi urban areas who underwent initial cervical cancer screening with an HPV test〔underwent once either between December 2018 and December 2019 (the 2019 yearly screening) or between January and June 2020 (the 2020 yearly screening) 〕 in Shihezi Maternal and Child Health Hospital, Shihezi People's Hospital, and First Affiliated Hospital, School of Medicine, Shihezi University during December 2018 to June 2020. Data of the screening results, including HPV infection rate and subtypes, Thinprep cytologic test results, and pathological diagnosis of cervical biopsy samples taken during a colposcopy were collected, and those of the 2019 yearly screening were compared with those of 2020 yearly screening.

Results

There were 18 378, and 28 616 attendees for 2019, and 2020 yearly screenings, respectively, and 44 746 of them finally completed the screening. The completion rate of cervical cancer screening in 2020 was higher than that in 2019 〔97.07% (27 779/28 616) vs (16 967/18 378) 〕 (P<0.05) . A total of 5 992 cases (12.75%) were detected with HPV infection, among them, the prevalence of HPV 16 and HPV 18 was 18.55% (1 112/5 992) , and that of other HPV subtypes was 81.45% (4 880/5 992) . The prevalence of HPV infections in participants of 2020 yearly screening〔11.09% (3 176/28 616) 〕was lower than that in participants of 2019 yearly screening〔15.32% (2 816/18 378) 〕 (P<0.05) . The prevalence of single-type HPV infections in participants of 2019 yearly screening was higher than that in participants of 2020 yearly screening 〔11.38% (2 092/18 378) vs 7.45% (2 674/28 616) 〕 (P<0.05) . The prevalence of multi-type HPV infections in participants of 2019 yearly screening was higher than that in participants of 2020 yearly screening〔3.94% (724/18 378) vs 1.75% (502/28 616) 〕 (P<0.05) . The prevalence of HPV was 10.37% (909/8 767) , 12.22% (1 916/15 677) , 13.71% (2 500/18 234) and 15.45% (667/4 316) , respectively, in four age groups of participants (30-39, 40-49, 50-59, and 60-65) in these two yearly screenings totally, showing an increase with age (P<0.05) . The prevalence of HPV showed a decrease in 30-39-year-old participants, so did it in 40-49-year-old, 50-59-year-old, and 60-65-year-old participants of 2020 yearly screening (P<0.05) . The top 5 prevalent single HPV subtypes found in 2019 yearly screening were HPV 52 (20.84%) , HPV 16 (14.48%) , HPV 53 (8.56%) , HPV 51 (7.93%) , and HPV 39/68 (7.60%) , while those found in 2020 yearly screening were HPV 52 (15.07%) , HPV 16 (12.64%) , HPV 58 (12.30%) , HPV 53 (10.25%) and HPV 66 (4.75%) . HPV 18 ranked as the 11th most prevalent single HPV subtype in both two screenings. The proportion of patients with pathological diagnosis of inflammation/condyloma and LSIL in cervical cancer screening in 2020 was lower than that in 2019 (P<0.05) . The 30-39-year-old participants of the 2020 yearly screening had lower prevalence of inflammation/condyloma detected by colposcopy than did those of the 2019 yearly screening (47.83% vs 74.36%) (P<0.05) . The 50-59-year-old participants of the 2020 yearly screening had lower prevalence of inflammation / condyloma detected by colposcopy than did those of the 2019 yearly screening (65.50% vs 77.22%) (P<0.05) . The 30-39-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected low-grade squamous intraepithelial lesion (LSIL) than did those of 2019 yearly screening (31.30% vs 5.13%) (P<0.05) . The 40-49-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected LSIL than did those of 2019 yearly screening (27.06% vs 16.07%) (P<0.05) . The 50-59-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected LSIL than did those of 2019 yearly screening (23.64% vs 8.89%) (P<0.05) .

Conclusion

The completion rate of cervical cancer screening in 2020 was obviously better than that in 2019, but it still needs to be further improved. Compared with 2019, HPV infection rate decreased, the major prevalent HPV subtypes changed, and LISL prevalence increased in 30-39 and 50-59 age groups in 2020. Follow-up management is suggested to be strengthened in 30-39 and 50-59 age groups.

Key words: Uterine cervical neoplasms, Screening, Human papillomavirus, Colposcopy, Age distribution, Women's health services

摘要：

背景

由于我国各地经济、文化发展水平参差不齐，宫颈癌防控实施效果也不尽相同，而了解各地宫颈癌筛查结果对制订有效的防治策略意义重大。

目的

对比2019年和2020年新疆石河子城区宫颈癌筛查结果，了解本地区妇女人乳头瘤病毒（HPV）感染及宫颈病变检出率的变化情况。

方法

回顾性收集2018年12月至2020年6月在新疆石河子市妇幼保健院、石河子市人民医院和石河子大学医学院第一附属医院以HPV为初筛的46 994例石河子城区妇女的宫颈癌筛查数据。2019年已行宫颈癌筛查妇女，2020年不再进行宫颈癌筛查。数据包括2019年和2020年HPV感染率及其亚型分布、薄层液基细胞学检测（TCT）及阴道镜宫颈组织活检病理诊断结果，并进行分析比较。

结果

2019年行宫颈癌筛查的妇女18 378例，2020年28 616例；最终完成宫颈癌筛查的妇女44 746例，2020年宫颈癌筛查完成率97.07%（27 779/28 616）高于2019年92.32%（16 967/18 378）（P<0.05）。2019年和2020年共检出HPV阳性5 992例（12.75%）。在HPV阳性人群中，HPV 16、18型阳性者占18.55%（1 112/5 992），其他亚型阳性者占81.45%（4 880/5 992）。2020年宫颈癌筛查HPV阳性率〔11.09%（3 176/28 616）〕低于2019年〔15.32%（2 816/18 378）〕（P<0.05）。2019年、2020年宫颈癌筛查HPV单一类型阳性率分别为11.38%（2 092/18 378）、7.45%（2 674/28 616），多种类型阳性率为3.94%（724/18 378）、1.75%（502/28 616）；2020年宫颈癌筛查HPV单一类型阳性率、多种类型阳性率均低于2019年（P<0.05）。2年30~39、40~49、50~59、60~65岁宫颈癌筛查妇女HPV阳性率依次为10.37%（909/8 767）、12.22%（1 916/15 677）、13.71%（2 500/18 234）、15.45%（667/4 316），HPV阳性率随年龄增高而增加（P<0.05）。相较于2019年，2020年30~39、40~49、50~59、60~65岁宫颈癌筛查妇女HPV阳性率均有下降（P<0.05）。2019年单一高危型HPV感染类型前5位依次为HPV 52型（20.84%）、HPV 16型（14.48%）、HPV 53型（8.56%）、HPV 51型（7.93%）和HPV 39型（7.60%）/HPV 68型（7.60%），2020年为HPV 52型（15.07%）、HPV 16型（12.64%）、HPV 58型（12.30%）、HPV 53型（10.25%）和HPV 66型（4.75%），HPV 18型2年均排在第11位。2020年宫颈癌筛查中病理诊断为炎症/湿疣、低级别鳞状上皮内病变（LSIL）者所占比例低于2019年（P<0.05）。2020年30~39、50~59岁进行阴道镜检查的妇女炎症/湿疣阳性率（47.83%、65.50%）低于2019年（74.36%、77.22%）（P<0.05）。2020年30~39、40~49、50~59岁进行阴道镜检查的妇女LSIL阳性率（31.30%、27.06%、23.64%）高于2019年（5.13%、16.07%、8.89%）（P<0.05）。

结论

新疆石河子城区2020年宫颈癌筛查完成情况较2019年明显改善，但仍需进一步提高。2020年宫颈癌筛查妇女HPV阳性率较2019年下降，且病毒感染主要类别发生变化。相较于2019年，2020年30~39、40~49、50~59岁进行阴道镜检查的妇女中LSIL阳性率上升，应加强该年龄段人群随访管理。

关键词: 宫颈肿瘤, 筛查, 人乳头瘤病毒, 阴道镜检查, 年龄分布, 妇女卫生保健服务

Yu LIU,Yan WEI,Ping YANG. Comparative Analysis of Cervical Cancer Screening Results in 2019 and 2020 in Shihezi Urban Areas, Xinjiang[J]. Chinese General Practice, 2022, 25(18): 2223-2230. DOI: 10.12114/j.issn.1007-9572.2022.02.007.
刘玉,韦艳,杨萍. 2019年和2020年新疆石河子城区宫颈癌筛查结果对比研究[J]. 中国全科医学, 2022, 25(18): 2223-2230. DOI: 10.12114/j.issn.1007-9572.2022.02.007.

Figures/Tables 10

References 17

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人群		2019年		2020年		χ²值	P值
人群		应检（例）	实检〔n（%）〕	应检（例）	实检〔n（%）〕	χ²值	P值
非HPV 16、18型的其他亚型阳性需行TCT者		2 229	1 090（48.90）	2 651	1 966（74.16）	330.083	<0.001
转诊阴道镜检查者		646	375（58.05）	761	609（80.03）	80.261	<0.001
	HPV 16、18型阳性者	587	337（57.41）	525	418（79.62）	62.708	<0.001
	非HPV 16、18型的其他亚型阳性且TCT结果≥AS-CUS者	59	38（64.41）	236	191（80.93）	7.422	0.006

人群		2019年		2020年		χ²值	P值
人群		应检（例）	实检〔n（%）〕	应检（例）	实检〔n（%）〕	χ²值	P值
非HPV 16、18型的其他亚型阳性需行TCT者		2 229	1 090（48.90）	2 651	1 966（74.16）	330.083	<0.001
转诊阴道镜检查者		646	375（58.05）	761	609（80.03）	80.261	<0.001
	HPV 16、18型阳性者	587	337（57.41）	525	418（79.62）	62.708	<0.001
	非HPV 16、18型的其他亚型阳性且TCT结果≥AS-CUS者	59	38（64.41）	236	191（80.93）	7.422	0.006

年龄（岁）	例数	HPV阳性率
30~39	8 767	909（10.37）
40~49	15 677	1 916（12.22）^a
50~59	18 234	2 500（13.71）^ab
60~65	4 316	667（15.45）^abc
χ²值		92.125
P值		<0.001

年龄（岁）	例数	HPV阳性率
30~39	8 767	909（10.37）
40~49	15 677	1 916（12.22）^a
50~59	18 234	2 500（13.71）^ab
60~65	4 316	667（15.45）^abc
χ²值		92.125
P值		<0.001

年龄（岁）	2019年		2020年		χ²值	P值
年龄（岁）	例数	HPV阳性率	例数	HPV阳性率	χ²值	P值
30~39	2 151	294（13.67）	6 616	615（9.30）	33.393	<0.001
40~49	6 300	921（14.62）	9 377	995（10.61）	56.425	<0.001
50~59	8 048	1 277（15.87）	10 186	1 223（12.01）	56.638	<0.001
60~65	1 879	324（17.24）	2 437	343（14.07）	8.152	0.004

Comparative Analysis of Cervical Cancer Screening Results in 2019 and 2020 in Shihezi Urban Areas, Xinjiang

2019年和2020年新疆石河子城区宫颈癌筛查结果对比研究

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HPV阳性类型（型）	2019年（n=2 092）	2020年（n=2 674）
HPV 52	436（20.84）	403（15.07）
HPV 16	303（14.48）	338（12.64）
HPV 53	179（8.56）	274（10.25）
HPV 51	166（7.93）	105（3.93）
HPV 39	159（7.60）	46（1.72）
HPV 68	159（7.60）	99（3.70）
HPV 33	126（6.02）	39（1.46）
HPV 58	126（6.02）	329（12.30）
HPV 56	104（4.97）	99（3.70）
HPV 66	94（4.49）	127（4.75）
HPV 18	66（3.15）	47（1.76）
HPV 31	65（3.11）	109（4.08）
HPV 35	55（2.63）	71（2.66）
HPV 59	36（1.72）	33（1.23）
HPV 45	18（0.86）	13（0.49）

年份（年）	例数	炎症/湿疣	LSIL	HSIL	CC	LSIL及以上	HSIL及以上
2019	375	268（71.46）	44（11.73）	54（14.40）	9（2.40）	107（28.53）	63（16.80）
2020	609	355（58.29）	161（26.44）	87（14.29）	6（0.98）	254（41.71）	93（15.27）
χ²值		17.342	30.422	0.002	3.095	17.342	0.366
P值		<0.001	<0.001	0.960	0.079	<0.001	0.545

年龄（岁）	2019年		2020年		χ²值	P值
年龄（岁）	例数	阳性率	例数	阳性率	χ²值	P值
30~39	39	29（74.36）	115	55（47.83）	8.269	0.004
40~49	112	72（64.29）	170	92（54.12）	2.869	0.090
50~59	180	139（77.22）	258	169（65.50）	6.976	0.008
60~65	44	28（63.64）	66	39（59.09）	0.229	0.632

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