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Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology?

  • Kingnate, Chalita (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University) ;
  • Supoken, Amornrat (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University) ;
  • Kleebkaow, Pilaiwan (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University) ;
  • Chumworathayi, Bundit (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University) ;
  • Luanratanakorn, Sanguanchoke (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University) ;
  • Kietpeerakool, Chumnan (Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University)
  • 발행 : 2015.11.04

초록

This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical records were reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen University Hospital. Logistic regression was used to determine the independent impact of age on the risk of high-grade pathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92 (19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99 (20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). The prevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95% CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independent predictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likely to have severe histopathology as the younger women. This study illustrates the substantial risk of underlying significant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significant independent factor predicting the risk of high-grade pathologies.

키워드

참고문헌

  1. Aue-Aungkul A, Punyawatanasin S, Natprathan A, et al (2011). See and treat approach is appropriate in women with highgrade lesions on either cervical cytology or colposcopy. Asian Pac J Cancer Prev, 12, 1723-6.
  2. Barreth D, Schepansky A, Capstick V, et al (2006). Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored. J Obstet Gynaecol Can, 28, 1095-8. https://doi.org/10.1016/S1701-2163(16)32330-1
  3. Bhogireddy V, Roston A, Chor J, et al (2014). Cervical intraepithelial neoplasia and cancer in women 35 years and older. J Low Genit Tract Dis, 18, 41-5. https://doi.org/10.1097/LGT.0b013e31828e831d
  4. Bosch X, Harper D (2006). Prevention strategies of cervical cancer in the HPV vaccine era. Gynecol Oncol, 103, 21-4. https://doi.org/10.1016/j.ygyno.2006.07.019
  5. Chen HC, Schiffman M, Lin CY, et al (2011). Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer. J Natl Cancer Inst, 103, 1387-96. https://doi.org/10.1093/jnci/djr283
  6. Dalstein V, Riethmuller D, Pretet JL, et al (2003). Persistence and load of high-risk HPV are predictors for development of high-grade cervical lesions: a longitudinal French cohort study. Int J Cancer, 106, 396-403. https://doi.org/10.1002/ijc.11222
  7. Kang LN, Castle PE, Zhao FH, et al (2014). A prospective study of age trends of high-risk human papillomavirus infection in rural China. BMC Infect Dis, 14, 96. https://doi.org/10.1186/1471-2334-14-96
  8. Kiatiyosnusorn R, Suprasert P, Srisomboon J, et al (2010). Highgrade histologic lesions in women with low-grade squamous intraepithelial lesion cytology from a region of Thailand with a high incidence of cervical cancer. Int J Gynaecol Obstet, 110, 133-6. https://doi.org/10.1016/j.ijgo.2010.03.022
  9. Kietpeerakool C, Srisomboon J, Tantipalakorn C, et al (2008). Underlying pathology of women with "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" smears, in a region with a high incidence of cervical cancer. J Obstet Gynaecol Res, 34, 204-9. https://doi.org/10.1111/j.1447-0756.2008.00758.x
  10. Kietpeerakool C, Tangjitgamol S, Srisomboon J (2014). Histopathological outcomes of women with abnormal cervical cytology: a review of literature in Thailand. Asian Pac J Cancer Prev, 15, 6489-94. https://doi.org/10.7314/APJCP.2014.15.16.6489
  11. Kjaer SK, Frederiksen K, Munk C, et al (2010). Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. J Natl Cancer Inst, 102, 1478-88. https://doi.org/10.1093/jnci/djq356
  12. Louro AP, Roberson J, Eltoum I, et al (2003). Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A follow-up study of conventional and liquid-based preparations in a high-risk population. Am J Clin Pathol, 120, 392-7. https://doi.org/10.1309/NPU3WRQCTAB81XLW
  13. Manopunya M, Suprasert P, Srisomboon J, et al (2010). Colposcopy audit for improving quality of service in areas with a high incidence of cervical cancer. Int J Gynaecol Obstet, 108, 4-6. https://doi.org/10.1016/j.ijgo.2009.07.042
  14. Moore MA, Attasara P, Khuhaprema T, et al (2010). Cancer epidemiology in mainland South-East Asia - past, present and future. Asian Pac J Cancer Prev, 11, 67-80.
  15. Paengchit K, Kietpeerakool C, Lalitwongsa S (2014). Prevalence and genotype distribution of HPV among women attending a cervical canceer screening mobile unit in Lampang, Thailand. Asian Pac J Cancer Prev, 15, 6151-4. https://doi.org/10.7314/APJCP.2014.15.15.6151
  16. Rodriguez AC, Garcia-Pineres AJ, Hildesheim A, et al (2011). Alterations of T-cell surface markers in older women with persistent human papillomavirus infection. Int J Cancer, 128, 597-607. https://doi.org/10.1002/ijc.25371
  17. Sawaya GF, Grady D, Kerlikowske K, et al (2000). The positive predictive value of cervical smears in previously screened postmenopausal women: the Heart and Estrogen/progestin Replacement Study (HERS). Ann Intern Med, 133, 942-50. https://doi.org/10.7326/0003-4819-133-12-200012190-00009
  18. Vaccarella S, Herrero R, Dai M, et al (2006). Reproductive factors, oral contraceptive use, and human papillomavirus infection: pooled analysis of the IARC HPV prevalence surveys. Cancer Epidemiol Biomarkers Prev, 15, 2148-53. https://doi.org/10.1158/1055-9965.EPI-06-0556