广西南宁地区妇女子宫颈HPV感染型别的分析

目的分析广西南宁地区妇女子宫颈HPV感染类型,研究其分布的规律。方法采用基因芯片法对1250名门诊机会性筛查的妇女按自愿原则采用HPV基因分型检测。结果HPv．DNA检测阳性者占31．36％（392／1250）。HPV-DNA亚型以低危型感染为主,感染率由高到低排列为6、11、43型;高危亚型感染率由高到低排列为16、58、52、18。HPV高危亚型以单一型别感染为主,其次为单一低危亚型感染。在多重感染中以低危和高危型别的二重混合感染为主;而三重、四重感染少见。感染者年龄≤25岁者占42．35％,其次为25～34岁。结论HPV感染亚型分布有一定的区域性,该检测可用于宫颈癌的筛查,以确定感染型别,有利于预测病变转归,指导临床治疗和随访。     

广西南宁地区妇女子宫颈HPV感染型别的分析

目的 分析广西南宁地区妇女子宫颈HPV感染类型,研究其分布的规律.方法 采用基因芯片法对1250名门诊机会性筛查的妇女按自愿原则采用HPV基因分型检测.结果 HPV-DNA检测阳性者占31.36%( 392/1250).HPV-DNA亚型以低危型感染为主,感染率由高到低排列为6、11、43型;高危亚型感染率由高到低排列为16、58、52、18.HPV高危亚型以单一型别感染为主,其次为单一低危亚型感染.在多重感染中以低危和高危型别的二重混合感染为主;而三重、四重感染少见.感染者年龄≤25岁者占42.35%,其次为25～34岁.结论 HPV感染亚型分布有一定的区域性,该检测可用于宫颈癌的筛查,以确定感染型别,有利于预测病变转归,指导临床治疗和随访.     

中国不同地区宫颈癌中HPV型别分布数据横向比较分析

目的：了解我国整体水平上人乳头瘤病毒（human papilloma virus,HPV）型别分布特征及各个地区HPV型别分布特点。方法：从2000-2012年发表关于我国HPV分布的研究中提取宫颈癌高危型HPV分布数据,分别按省份和行政地区对HPV型别数据进行加权合并和比较,以了解各个地区HPV型别的分布特点。并根据地区预计年宫颈癌死亡人数对HPV型别数据进行权重调整,推算出全国宫颈癌HPV整体阳性率和各型别阳性比率。结果：共有31篇研究符合纳入标准,包括18个省直辖市或地区的5081例宫颈癌样品。加权合并后HPV整体感染率为89．6％（95％CI：87．4oA～91．7％;12—88．9％）,各省间差异较大（78．7％～97．2％）。有16篇研究给出了HPVl6和（或）18感染的具体数据,加权合并后,HPV阳性样品中HPVl6／18感染比率为86．1％（95％CI：82．9％～89．4％;I2=81．0％）。根据地区年预期死亡人数对HPV感染率进行权重调整后,全国水平上HPV整体阳性率达到87．7％。HPV16、HPV18、HPV58、HPV33、HPV52、HPV31、HPV45和HPV59是我国宫颈癌中最主要的8个高危HPV型别。在所有地区HPV16均为最主要感染型别,HPVl8在多数地区为第二主要感染型别。HPV45、HPV52和HPV58分别为内蒙古、甘肃和四川省的第二主要感染型别。8个主要HPV型别的阳性比率在地区间的差异明显。结论：在我国整体水平上,HPVl6和HPVl8为宫颈癌中最主要型别,HPV58、HPV33、HPV52、HPV31、HPV45和HPV59等型别在个别地区的宫颈癌中分别有着很高的感染率。     

肿瘤组织中人乳头瘤病毒HPV基因组相关序列的检测

本文报道应用核酸分子杂交方法,以[α-(32)P]-dTTP标记的HPV16型基因组为探针,共检测恶性肿瘤53例(标本包括宫颈癌22例,阴茎癌3例、膀胱癌6例、肾癌3例、肺癌7例、胃癌1例、结肠癌11例)、7例良性肿瘤、8例正常上皮组织中HPV基因组相关序列。检测结果表明,在恶性肿瘤中仅于宫颈癌组织检测出HPV16型基因组相关序列59.1％,P<0.01。而良性肿瘤和正常上皮组织中均未检测出HPV16型和其他型别基因组相关序列。此种阴性结果,可能与地理分布、病变组织的病理类型、检测使用的探针和方法、例数少等因素有关。为进一步探讨HPV感染与肿瘤的关系,尚需深入研究。     

高危型HPV负荷量与宫颈病变及术后随访的相关研究

[目的]探讨高危型HPV负荷量与宫颈病变及术后病毒持续感染的关系。[方法]对2008年1月至2012年11月体检发现的高危型HPV阳性且行宫颈LEEP术的749例患者临床资料及随访结果进行分析,观察高危型HPV负荷量与宫颈病变及术后病毒持续感染的关系。[结果]高危型HPV负荷量越大,宫颈病变级别越高。术后3个月高危型HPV阳性率约27．9％;术后6个月约8-3％;术后9个月约4．0％。宫颈LEEP术后3、6个月患者高危型HPV阳性表达率下降显著（术后3个月vs术前：χ2=-844．38,P=0．0001;术后6个月vs术后3个月：χ2=97．35,P=0．0001）;术后9个月高危型HPV阳性表达率较术后6个月下降,但无显著性差异。术前高危型HPV负荷量〈100RLU,CO、100～1000RLU,CO及〉1000RLU／CO三组术后6个月复查HPV阳性率分别为5.3％、9.4％及12．9％（P〈0．05）。[结论]高危型HPV负荷量与宫颈病变严重程度及持续感染存在明显相关性,针对高负荷量者需严密诊治及随访。     

早期宫颈癌前哨淋巴结中高危型HPV16/18 DNA表达的检测及临床意义

目的：探讨早期宫颈癌患者前哨淋巴结（SLN）中人乳头状瘤病毒（HPV）16/18 DNA表达检测对于微转移的临床意义。方法选取72例早期宫颈癌患者,予患者均行广泛性子宫切除加双侧盆腔淋巴结清扫术,术中采用染料法识别SLN的宫颈癌患者有46例,应用基因检测法（FQ-PCR）检测SLN中HPV16/18 DNA阳性表达情况,并分析其与各种临床病理因素的关系;对SLN病理阴性的33例患者进行长期随访,分析SLN中HPV16/18 DNA阳性与淋巴结转移的关系。结果46例宫颈癌患者SLN中HPV16/18 DNA阳性表达者共22例,其中13例淋巴结病理阳性患者中有10例阳性,而33例淋巴结病理阴性患者中仅12例阳性（P=0.013）;46例患者共检出前哨淋巴结102枚,均用FQ-PCR法检测HPV16/18 DNA,结果13例淋巴结病理阳性患者检出的37枚SLN中有29枚HPV16/18 DNA阳性,而33例淋巴结病理阴性患者检出的65枚SLN中仅有36枚阳性（P=0.033）;分析46例成功检出SLN的早期宫颈癌患者的临床资料,发现SLN中HPV16/18 DNA阳性表达仅与临床分期有关,具有统计学意义（P=0.034）;长期随访33例SLN病理阴性的患者,发现HPV16/18 DNA阳性的患者复发率高于HPV16/18 DNA阴性的患者,具有统计学意义（P=0.02）。结论检测宫颈癌SLN组织中HPV16/18 DNA表达可能是预测早期宫颈癌淋巴结微转移的可行方法。     

宫颈癌组织中人乳头瘤病毒HPV16型基因组同源序列的检测

本文报道应用Southern blot核酸分子杂交技术,以标记的国内HPV16型基因组分子为探针,共检测22例宫颈癌、4例宫颈不典型增生、6例宫颈慢性炎症,5例宫颈内膜息肉,6例正常宫颈上皮组织中的HPVl6型基因组同源序列。杂交结果表明,宫颈癌组织中HPV16型基因组同源序列阳性率为36.4％(相关序列阳性率为59.1％),非癌组织和正常宫颈上皮组织均为阴性,P<0.05具有显著性差异。同时还观察到宫颈癌病理组织学特征和组织细胞体外培养CPE与HPV16型基因组同源序列检出率呈正相关,P<0.001。更进一步证明宫颈癌发病与HPV感染密切相关。并提出HPV感染的初筛检测方法。     

新疆维吾尔族妇女宫颈癌HPV感染型别分布研究

目的探讨人乳头瘤状病毒(HPV)在新疆南部维吾尔族妇女宫颈癌患者的型别分布情况,为开发适宜该地区的HPV疫苗提供一定的理论依据.方法收集2008年6月至2010年4月就诊于新疆维吾尔自治区人民医院妇科的经病理确诊的新疆南部地区维吾尔族妇女宫颈癌患者120例,利用聚合酶链反应(PCR)和基因芯片技术检测HPV DNA并分...     

Socioeconomic inequalities and oral cancer risk: a systematic review and meta-analysis of case-control studies

There is uncertainty and limited recognition of the relationship between socioeconomic inequalities and oral cancer. We aimed to quantitatively assess the association between socioeconomic status (SES) and oral cancer incidence risk. A systematic review of case-control studies obtained published and unpublished estimates of the SES risk related to oral cancer. Studies were included which reported odds ratios (ORs) and corresponding 95% CIs of oral cancer with respect to SES, or if the estimates could be calculated or obtained. Meta-analyses were performed on subgroups: SES measure, age, sex, global region, development level, time-period and lifestyle factor adjustments; while sensitivity analyses were conducted based on study methodological issues. Forty-one studies provided 15,344 cases and 33,852 controls which met our inclusion criteria. Compared with individuals who were in high SES strata, the pooled ORs for the risk of developing oral cancer were 1.85 (95%CI 1.60, 2.15; n = 37 studies) for those with low educational attainment; 1.84 (1.47, 2.31; n = 14) for those with low occupational social class; and 2.41 (1.59, 3.65; n = 5) for those with low income. Subgroup analyses showed that low SES was significantly associated with increased oral cancer risk in high and lower income-countries, across the world, and remained when adjusting for potential behavioural confounders. Inequalities persist but are perhaps reducing over recent decades. Oral cancer risk associated with low SES is significant and comparable to lifestyle risk factors. Our results provide evidence to steer health policy which focus on lifestyles factors toward an integrated approach incorporating measures designed to tackle the root causes of disadvantage.     

宫颈癌及癌前病变中IL-10表达和HPV感染的相关性研究

目的:研究宫颈疾病病灶中IL-10表达与高危型人类乳头瘤病毒(HPV)感染情况及其相关性,从而了解宫颈疾病病灶局部免疫逃逸的可能机制。方法:收集118例宫颈分泌物及宫颈组织,其中浸润性宫颈鳞癌40例,22例宫颈上皮内瘤变(CIN)1,18例CIN2,18例CIN3,正常女性宫颈组织20例。采用第二代杂交捕获法检测与宫颈感染高危型HPV的情况,RT-PCR法测定宫颈组织IL-10 mRNA的表达。结果:在正常宫颈、CIN1、CIN2-3和宫颈浸润癌组织中,高危HPV感染的比例依次为5.00%、40.91%、83.33%和100.00%。IL-10 mRNA表达率依次为0、18.18%、52.78%和87.50%,在高危HPV感染的CIN1、CIN2-3和宫颈浸润癌组织中的比例依次为44.44%、63.33%和87.50%。各组之间差异有统计学意义,P<0.05。结论:IL-10抑制宫颈局部免疫反应是宫颈HPV感染导致宫颈癌前病变及宫颈癌发生发展的重要因素,IL-10的表达与HPV和子宫颈癌疾病的阶段有明显相关性,可能有助于肿瘤部位微环境的免疫抑制作用。     

Race in ovarian cancer treatment and survival: a systematic review with meta-analysis

Objective  There has long been recognition of racial disparities in cancer treatment and survival. In order to investigate the etiology of racial disparities in ovarian cancer, we undertook a systematic review of the published literature. Methods  Focusing on North America, our search of MEDLINE, PsychInfo, and EMBASE databases recovered 513 abstracts of which 98 underwent full text screening resulting in 24 studies included in the final review. After assessing heterogeneity, results were pooled where possible in a meta-analysis using a random effects model. Results  Eight articles reported treatment outcomes, nine survival, and seven both. Overall African Americans were less likely to receive any form of surgical treatment for ovarian cancer [pooled relative risk (RR) 1.17 (95% confidence interval (CI): 1.10, 1.23)] compared with white women. Although the majority of the included articles reporting survival outcomes did not control for known covariates such as medical co-morbidities or treatment, we were able to pool the unadjusted results from eight articles. Taken together the meta-analysis of 106,704 women did not find a difference in five-year survival between whites and African Americans, RR 1.07 (95% CI: 0.97, 1.18). When the results were stratified by year of cancer diagnosis, studies which captured patients prior to 1985 yielded a five-year RR of survival for whites compared to African Americans of 0.93 (95% CI: 0.89, 0.97) compared with 1.17 (95% CI: 1.05, 1.31) after 1985. Conclusion  These results suggest that racial disparities in ovarian cancer are not due to underlying biological differences rather to the unequal application of existing treatments. Previous presentation of results  The results from this study were presented at the XVIII IEA World Congress of Epidemiology, September 20–24, 2008 in Porto Alegre, Rio Grande do Sul, Brazil.     

Body size and composition and prostate cancer risk: systematic review and meta-regression analysis

The evidence that measures of obesity and stature are associated with prostate cancer is weak and inconsistent. We performed a systematic review and meta-analysis of the relationship between body mass index (BMI), height, weight, waist circumference and waist-to-hips ratio (WHR) and the risk of prostate cancer. Study-specific dose-response slopes were obtained, and random effects rate ratios (RRs) were computed from linear meta-regression models. We included 55,521 cases identified among 2,818,767 men from 31 cohort studies, and 13,232 cases and 16,317 controls from 25 case–control studies. The overall RR for BMI was 1.05 per 5 kg/m² increment, 95% CI 1.01–1.08. For studies that reported results by stage of disease, the RRs were stronger for advanced disease (RR 1.12 per 5 kg/m² increment, 95% CI 1.01–1.23) compared with localized disease (RR 0.96 per 5 kg/m² increment, 95% CI 0.89–1.03), p = 0.02. Height was also positively associated with risk (RR 1.05 per 10 cm increment, 95% CI 1.02–1.09), but the evidence was weak for weight (RR 1.01 per 10 kg increment, 95% CI 0.97–1.04), waist circumference (RR 1.03 per 10 cm increment, 95% CI 0.99–1.07), and WHR (RR 1.11 per 0.1 unit increment, 95% CI 0.95–1.30). Stronger associations were observed among cohort studies compared with case–control studies for BMI (p = 0.006), height (p < 0.001) and weight (p = 0.02). This meta-analysis indicates that obesity is weakly associated with an increased risk of prostate cancer (particularly advanced stage tumors). While increased stature may also increase risk, there is little evidence for an association with central obesity.     

High-intensity focused ultrasound for prostate cancer: a systematic review

High-intensity focused ultrasound (HIFU) has recently been promoted as a non-invasive treatment option for prostate cancer. This systematic review sought to evaluate the evidence comparing it with standard treatment in patients with localised prostate cancer. The literature review included searches of MEDLINE, EMBASE, the Cochrane Library, annual meetings’ abstracts and websites of evidence-based practice guideline producers. Studies were included if they were randomised controlled trials comparing HIFU with current management approaches, or were meta-analyses, systematic reviews or practice guidelines addressing HIFU. No randomised controlled trials or meta-analyses were identified. Seven systematic reviews and two practice guidelines were identified; neither contained randomised controlled trials. Adjusting the selection criteria to include case series found 34 clinical studies of HIFU. Twenty-nine evaluated HIFU as the primary treatment and five examined HIFU as salvage treatment for recurrence after radiotherapy. In most studies the outcomes used to determine efficacy were negative biopsy rates or prostate-specific antigen (PSA) levels. Among the 29 studies of HIFU as the primary treatment, negative biopsy rates ranged from 35 to 95% in 21 studies, a PSA nadir of ≤0.5 ng/ml ranged from 55 to 91% in 10 studies and mean PSA nadirs ranged from 0 to 1.9 ng/ml in 17 studies. Five studies reported 5-year disease-free survival rates ranging from 55 to 95%. Among five studies of HIFU as salvage treatment, negative biopsy rates ranged from 73 to 84% in four studies, a PSA nadir of ≤0.5 ng/ml ranged from 57 to 66% in three studies and mean PSA nadirs were 1.97 and 2.38 ng/ml in two studies, respectively. Current evidence on HIFU use in prostate cancer patients is of low quality, rendering it difficult to draw conclusions about its efficacy. Until results from case series are confirmed in prospective studies, the widespread use of HIFU is not supported.     

Tobacco smoking and lung cancer risk: an evaluation based on a systematic review of epidemiological evidence among the Japanese population

BACKGROUND: Although tobacco smoking is the best established risk factor for lung cancer, the association is not as strong among Japanese as among Western populations. It would be of value, therefore, to quantify that association in Japan based on a systematic review of epidemiological evidence for the primary prevention of lung cancer. METHODS: Original data were obtained from MEDLINE searches using PubMed, supplemented with manual searches. The evaluation of associations was based on the strength of evidence and the magnitude of the association, together with biological plausibility as previously evaluated by the International Agency for Research on Cancer. A meta-analysis was also conducted to estimate the summary measure of those associations. RESULTS: A total of 8 cohort studies and 14 case-control studies were identified, almost all of which consistently showed a strong association of current smoking with the risk of lung cancer. The summary relative risk for current smokers versus never smokers was estimated as 4.39 (95% confidence interval 3.92-4.92) for men and 2.79 (95% confidence interval 2.44-3.20) for women. Cohort studies and case-control studies gave reasonably consistent summary measures. The summary relative risks were 11.7 and 2.30 for squamous cell carcinoma and adenocarcinoma, respectively, in men, and were 11.3 and 1.37 correspondingly in women. CONCLUSION: There is convincing evidence that tobacco smoking strongly increases the risk of lung cancer in the Japanese population, with the relative risk for current smokers compared with never smokers measuring around 4.4 for men and 2.8 for women.     

Adherence to oral antineoplastic agents by cancer patients: definition and literature review

Since the 1990s, oral chemotherapy has been gaining ground as cancer treatment. This therapy seems to have few toxic effects and offers patients good quality of life. However, in addition to the fears the therapy might generate in patients, oral treatment raises a new issue, which, until now, has been marginal in this field: therapeutic observance or adherence. We investigated the research into adherence to oral chemotherapy among cancer patients published between 1990 and July 2013. Studies showed considerable diversity in terms of both the definition and measurement of adherence. As well, adherence to antineoplastic therapy is affected by the patient's understanding of the treatment and ability to remember information provided by the physician, treatment length and psychological distress. Our review of the few studies on adherence to anticancer drug treatment raises some questions that could be pursued in future research. In light of our findings, patients should receive ‘therapy education’ to help them and their support groups better understand the disease and its treatment and to achieve optimal health management and improved treatment effectiveness.     

P53 abnormalities and outcomes in colorectal cancer: a systematic review

We performed a systematic review of studies that investigated the effect of abnormalities of the tumour suppressor gene p53 upon prognosis in patients with colorectal cancer. The methods used to assess p53 status were immunohistochemistry (IHC), indicating abnormal accumulation of p53, and sequence analysis, indicating presence of p53 mutations (mut). We identified 168 reports, with 241 comparisons of relevant end points and survival data on 18 766 patients. We found evidence of both publication bias and heterogeneity of results. Our analysis was hampered by variability in both the assessment of p53 status and the reporting of results. We used a trim and fill method to correct for publication bias and minimised heterogeneity by using well-defined clinical subgroups for the assessment of outcomes. Overall, patients with abnormal p53 were at increased risk of death: relative risk (RR) with IHC 1.32 (95% confidence interval (c.i.) 1.23-1.42) and with mutation analysis 1.31 (95% c.i. 1.19-1.45). The adverse impact of abnormal p53 was greater in patients with lower baseline risk of dying: good prognosis RR (mut) 1.63 (95% c.i. 1.40-1.90) and poor prognosis RR (mut) 1.04 (95% c.i. 0.91-1.19). We found no effect of abnormal p53 on outcome in patients treated with chemotherapy. Abnormal p53 was associated with failure of response to radiotherapy in patients with rectal cancer: RR (mut) 1.49 (95% c.i. 1.25-1.77).     

Alcohol drinking and lung cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population

BACKGROUND: The relationship between alcohol consumption and risk of lung cancer is controversial. Based on a systematic review of epidemiologic evidence, we evaluated this association among the Japanese population, who may be more susceptible to alcohol-related diseases than Western populations. METHODS: Original data were obtained from MEDLINE searches using PubMed or from searches of the Ichushi database, complemented with manual searches. The evaluation of associations was based on the strength of evidence and the magnitude of association, together with biological plausibility as previously evaluated by the International Agency for Research on Cancer. RESULTS: We identified seven cohort studies and two case-control studies. One cohort study demonstrated a strong positive association between alcohol drinking and the risk of female lung cancer, but the association almost disappeared after adjustment for smoking. The other eight studies showed a weak positive or no association. Although smoking is the best-established risk factor for lung cancer, only five cohort studies presented smoking-adjusted risks out of all nine identified. Furthermore, only two studies explicitly reported the risk estimate for ex-drinkers who may have quit alcohol drinking after the development or diagnosis of the disease and have an apparently higher risk. CONCLUSION: We conclude that the epidemiologic evidence on the association between alcohol drinking and lung cancer risk remains insufficient in terms of both the number and methodological quality of studies among the Japanese population.     

Medication adherence to oral anticancer drugs: systematic review

Many studies have demonstrated that non-adherence to oral anticancer drugs (OACDs) has challenged treatment efficacy. Otherwise, few validated tools exist to measure patients’ adherence to medication regimen in clinical practice. To synthesize previous studies on adherence by cancer patients taking OACDs, especially in targeted therapy, a systematic search of several electronic databases was conducted. We analyzed existing scales’ contents for various cancer patients and outcomes of studies assessing adherence. However, a well-validated scale designed particularly for OACD adherence is still lacking. Most adherence scales used in the studies reviewed contain items focused on measuring patients’ medication-taking behavior more than their barriers to medication compliance and beliefs. However, non-adherence to OACDs is a complex phenomenon, and drug-taking barriers and patient beliefs significantly affect patients’ non-adherence. To understand the key drivers and predisposing factors for non-adherence, we need to develop a well-validated, multidimensional scale.