Severe cervical inflammation and high-grade squamous intraepithelial lesions: a cross-sectional study

Cervical intraepithelial neoplasia and cervical cancer in Hunan Province, China, 2020-2023

Objective

To describe the incidence and distribution of cervical intraepithelial neoplasia (CIN) and cervical cancer (CC) for rural women aged 35-64 in Hunan Province, China, 2020-2023.

Methods

Data were from the Hunan Provincial Cervical Cancer Screening Program in Rural Areas. Most rural women aged 35-64 in Hunan Province attend the program. All women diagnosed with CINs and CCs will be asked to register detailed information, including pelvic examination, diagnosis, age, education level, etc. CINs included low-grade squamous intraepithelial lesions (LSIL) (CIN1), high-grade squamous intraepithelial lesions (HSIL) (CIN2 and 3); CCs included adenocarcinoma in situ (AIS), early invasive cervical cancer (EICC) (stage Ia1 and Ia2) and invasive cervical cancer (ICC) (stage Ib and above). The incidence of CIN and CC is the number of cases per 1000 women. Chi-square tests (χ2 ) were used to examine if there were significant differences in proportions among different groups.

Results

A total of 4150700 women were included, and 67071 CINs and CCs were identified. The incidence of LSIL, HSIL, AIS, EICC and ICC were 10.63‰(95%CI: 10.53-10.73), 4.98‰(95%CI: 4.91-5.05), 0.06‰(95%CI: 0.06-0.07), 0.23‰(95%CI: 0.22-0.25), and 0.26‰(95%CI: 0.24-0.27), respectively. The proportion of previous pelvic examinations was relatively low in EICC (17.24%) and ICC (17.45%) (χ2 = 236.57, P <0.01), present abnormal examination was relatively high in AIS (51.33%), EICC (49.74%) and ICC (62.45%) (χ2 = 331.15, P <0.01). HPV16 was the most common high-risk type for LSIL (22.01%), HSIL (36.92%), AIS (46.01%), EICC (58.88%), and ICC (64.34%). The proportion of HSIL was relatively high in women aged 35-44 (27.03%), AIS was relatively high in women aged 45-54 (46.39%), EICC (44.24%), and ICC (48.58%) was relatively high in women aged 55-64. The proportion of ICC was relatively high in women with elementary school (38.68%), HSIL (15.10%) and AIS (17.49%) was relatively high in women with senior high school, AIS (1.52%), EICC (0.62%) and ICC (0.75%) was relatively low in women with university and above. (P <0.01).

Conclusion

We have described the incidence and distribution of CIN and CC among rural women aged 35-64. These findings were clinically relevant and were useful for clinical counseling and early diagnosis of CC.

Prognostic Prediction for Recurrent/Residual CIN in HSIL Patients After Conization: An Updated Retrospective Study Based on Ambulatory Surgery

Background

There are currently few prognostic models for conization in patients with high-grade squamous intraepithelial lesion (HSIL) because it is a rapid procedure that typically collects less case information. The present study aimed to establish a rapid/accurate postoperative prognostic assessment model for these patients.

Methods

This study included 631 nonpregnant participants with HSIL confirmed by histopathology from January 2015 to January 2018. The recurrent/residual cervical intraepithelial neoplasia (CIN) were divided into residual CIN, simple recurrent CIN and recurrent CIN accompanied with CIN progression. The recurrence/residual-free survival (RFS) time was defined as the time span from the time of surgery (baseline) until the first lesion of CIN was detected or the 1-/3-/5-year follow-up endpoint was reached.

Results

After LASSO regression selection, the higher platelet-to-lymphocyte ratio (PLR) (OR = 1.006, p = 0.002), positive margin status (OR = 2.451, p = 0.021), HPV-16 (OR = 4.414, p < 0.001), -18 (OR = 3.040, p = 0.009), -56 (OR = 10.715, p=0.021), and non-HR-HPV (OR = 2.487, p = 0.028) infection showed significant difference in the Logistic model. And HPV-16 infection (OR = 6.159, p = 0.001) could promote recurrent CIN accompanied with CIN progression. In multivariate Cox regression models, the higher PLR (HR = 1.005/1.005/1.005, p = 0.020/0.002/0.003) and HPV-16 infection (HR = 2.758/2.836/2.674, p < 0.001) showed statistical difference during 1-/3-/5-year follow-up. While gland invasion (p = 0.081), margin status (p = 0.075) and HPV infection genotype (p = 0.150) did not showed statistical difference in multivariate Cox regression models based on LASSO regression. And gland invasion (p = 0.251/0.686) and HPV-58 infection (p = 0.148/0.813) also showed no statistical difference in optimized Logistic regression models.

Conclusion

HPV-16, -18, -56 and non-HR-HPV infection status can be considered as indicators for recurrent CIN during the 5-year follow-up, especially for HPV-16 infection, which also lead to a CIN recurrence accompanied with disease progression. And the preoperative PLR level, gland invasion, positive margin may be predictors for recurrent/residual CIN during 1-, 3- and 5-year follow-up.

Prevalence of high-risk human papillomavirus genotypes and viral load correlated with squamous cell inflammation among women in Gabon

BACKGROUND

High-risk genotypes of Human Papillomavirus are responsible for 90% of cases of cervical cancer worldwide. Inflammation of squamous cells is mainly linked to HPV. In Gabon, HPV is endemic and circulates among the female population. The study aimed to determine the prevalence of HR-HPV genotypes and to investigate the correlation between squamous cell inflammation and HPV viral load in infected women in Gabon.

METHODS

The cross-sectional study was conducted at Libreville University Hospital Center (UHC) and National Public Health Laboratory from March to May 2024 among 399 women. Two cervical smears were taken. Genotype detection was carried out by multiplex fluorescence real-time PCR in the NPHL virology unit. Cytology was carried out in UHC's anatomic-pathology laboratory. Data were analyzed by SPSS software. Graphs were plotted using Microsoft Excel 2016.

RESULTS

The prevalence of Human Papillomavirus was 26.1% (95% CI: 22-30.6). The prevalence of HR-HPV genotypes was 24.8%. The most common HR-HPV genotypes were HPV-16/52/18/35/56/58/53/68. The rate of multiple HPV infections was 29.8% and 95.2% for the HR-HPV infection rate. Viral load was significantly correlated with squamous cell inflammation (r = 0.977 and P = 0.001).

CONCLUSION

HR-HPV infection remains a concern in women, however early screening is necessary for optimal monitoring and management. HR-HPV viral load is a predictive marker of squamous cell inflammation.

Bacterial Vaginosis Decreases the Risk of Cervical Cytological Abnormalities

Genital tract infections, including vulvovaginal candidiasis and bacterial vaginosis, have emerged as potential modulators of persistent human papillomavirus (HPV) infections causing cervical cytologic abnormalities and cervical cancer. This study aimed to investigate whether vulvovaginal candidiasis or bacterial vaginosis had an additional effect on HPV infection and thus caused such abnormalities. ThinPrep cytologic tests were used to detect cytologic abnormalities, vulvovaginal candidiasis, and bacterial vaginosis in 14,679 women. Cytologic abnormalities included atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, atypical squamous cells-cannot exclude HSIL, and squamous cell carcinoma. Logistic regression Model 1 (univariate regression) and Model 2 (multivariate logistic regression analysis adjusted for age combined with HPV infection) were used to analyze the association between bacterial vaginosis and cytologic abnormalities, or vulvovaginal candidiasis and cytologic abnormalities, alone or in the presence of HPV infection. Bacterial vaginosis infection rates were found to be significantly higher in the cytology-negative group among all participants and those with HPV infection (P = 0.003, P < 0.001, respectively). Analyses using Model 1 and Model 2 both pointed to bacterial vaginosis as a protective factor against cytologic abnormalities for all participants (OR = 0.36, 0.17, respectively, P < 0.05) and for HPV-infected participants (OR = 0.17, 0.16, respectively, P < 0.05). Neither vulvovaginal candidiasis nor vulvovaginal candidiasis + HPV was significantly associated with the incidence of cytologic abnormalities based on Model 1 (OR = 0.94, 0.71, respectively, P > 0.05) and Model 2 (OR = 0.91, 0.74, respectively, P > 0.05). Furthermore, neither vulvovaginal candidiasis nor bacterial vaginosis increased the incidence of cytologic abnormalities regardless of HPV infection status, while bacterial vaginosis might possibly prevent cytologic abnormalities in women coinfected by HPV.

PREVENTION RELEVANCE

Neither vulvovaginal candidiasis nor bacterial vaginosis was found to increase the incidence of cervical cytologic abnormalities with or without the presence of HPV. On the contrary, bacterial vaginosis may play a role in preventing cytologic abnormalities in women with HPV coinfection.

Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP

Purpose

The platelet-to-lymphocyte ratio (PLR) is considered correlated with cancer prognosis including cervical cancer, in addition to high-risk papillomavirus (HR-HPV) infection, of which the predictive value in prognosis of high-grade squamous intraepithelial lesions (HSILs) remains unknown. Here, the prognostic predictive value of PLR in HSIL after loop electrosurgical excision procedure (LEEP) was evaluated.

Patients and Methods

This study included 335 nonpregnant participants with histopathologically confirmed HSIL and 3- and 5-year follow-ups from the Fujian Cervical Lesions Screening Cohorts (FCLSCs) between September 2016 and September 2018. PLR and other variables were evaluated to identify the factors related to the recurrence/residual cervical intraepithelial neoplasia (CIN)-free survival (RFS), namely, the time from LEEP at baseline to first detection of recurrence/residual CIN or end of follow-up, by logistic and Cox regression.

Results

In the Kaplan‒Meier analysis, HR-HPV infection (p=0.049/0.012), higher PLR (p=0.031/0.038), and gland invasion (p=0.047) had a higher risk for recurrence/residual CIN at the 3-/5-year follow-up. The univariate logistic and Cox regression analyses showed significant differences and a higher cumulative risk in patients with HR-HPV infection (OR=3.917, p=0.026; HR=3.996, p=0.020) and higher PLR (OR=2.295, p=0.041; HR=2.161, p=0.030) at the 5-year follow-up. The findings by multivariate Cox regression analysis were similar, indicating a poor prognosis for patients with HR-HPV infection (HR=3.901, p=0.023) and higher PLR (HR=2.082, p=0.038) at the 5-year follow-up. The calibration plot showed a better model fit for RFS at the 3-year follow-up.

Conclusion

Preoperative PLR level and HR-HPV infection could be available markers for predicting recurrence/residual disease of HSIL after LEEP. Clinically, combining PLR with HR-HPV tests may provide novel evaluation method and reference for management in post-treatment patients with cervical precancerous lesions.

Absolute band neutrophils count is a predictor of overall survival in advanced uterine cervical cancer

PURPOSE

Neutrophils play a role during the oncogenic process, and their count can be a prognostic marker. The objective was to evaluate the association of band and segmented neutrophils with prognostic factors, overall survival, and disease-free survival in advanced uterine cervical cancer (IIB to IVB staging).

METHODS

This study evaluated 88 patients diagnosed with uterine cervical cancer staging IIB to IVB. The recorded data from medical records were age, parity, staging, histological type, absolute count of total neutrophils, band neutrophils and segmented neutrophils, disease-free survival, and overall survival. Receiver-operating characteristic (ROC) curve was used to obtain the area under the curve (AUC) and determine the best cut-off values for each parameter. Survival was verified by the Kaplan-Meier method, and multivariate analysis was performed by Cox regression. The level of significance was ≤ 0.05.

RESULTS

Regarding the total neutrophils, band, and segmented neutrophils count, a cut-off value of 6187/mm³, 273 mm³ and 6062/mm³ were found, respectively. Overall survival was shorter in patients with total neutrophils greater than 6187/mm³ (p = 0.012), band neutrophils greater than 273/mm³ (p = 0.001), and segmented neutrophils greater than 6062/mm³ (p = 0.013). After multivariate analysis considering the two types of neutrophils, only band neutrophils greater than 273/mm³ remained as an independent factor for shorter overall survival.

CONCLUSION

The absolute count of band neutrophils greater than 273/mm³ was a potential predictor of shorter overall survival in women with invasive cervical cancer. This count can be of great clinical use, in addition to being inexpensive, less invasive, and easy to perform.