HPV阴性宫颈癌的实验室验证及临床分析

Laboratory verification and clinical analysis of HPV-negative cervical cancer

目的:探讨细胞学HPV阴性宫颈癌的实验室验证方法及其临床特点。方法:收集2015年9月至2018年10月在贵州医科大学附属肿瘤医院、病理学诊断为宫颈癌、宫颈脱落细胞凯普21分型(K-21)检测HPV阴性的患者33例,同期HPV阳性宫颈癌患者60例。病理石蜡标本、分子病理学(凯普膜杂交法+PCR)3种试剂盒(K-14、K-18和K-37)进行实验室验证。分析HPV阴性与阳性宫颈癌的临床特点。结果:细胞学阴性宫颈癌33例经组织石蜡切片、分子病理学方法检测,K-14和K-18试剂盒13例阴性,K-37试剂盒9例阴性。分子病理学HPV阴性宫颈癌9例与阳性组84例患者首发临床表现有统计学差异,阴性组接触性出血、不规则阴道流血所占比例小于阳性组(3/9∶41/84,1/9∶33/84;字2=12.889,P=0.006);就诊时的FIGO分期有统计学差异,阴性组Ib2期、IIa2期、Ⅲ/Ⅳ期所占比例大于阳性组(3/9∶13/84,1/9∶7/84,2/9∶0/84;字2=12.786,P=0.021);病理类型有统计学差异,阴性组腺癌所占比例大于阳性组(3/9∶5/84;字2=5.752,P=0.041);手术患者肿瘤浸润深度有统计学差异,阴性组早浸、浸润至宫颈外口、浸润至宫体所占比例大于阳性组(2/7∶6/64,2/7∶14/64,3/7∶11/64;字2=8.332,P=0.035)。结论:理论上HPV阴性的宫颈癌是存在的。临床上HPV阴性宫颈癌有首发临床表现不典型、就诊时FIGO分期较晚及腺癌所占比例较大的特点。

Objective:To explore the laboratory verification methods and clinical characteristics of cytological HPV-negative cervical cancer.Methods:From September 2015 to October 2018,33 cervical cancer patients with HPV-negative and pathologically diag-nosed by cervical exfoliated cell Hybribio 21 typing(K-21)and 60 HPV-positive cervical cancer patients in the same period were collected.Laboratory validation was carried out with pathological paraffin specimens,molecular pathology(hybribio membrane hybridization+PCR)kits(K-14,K-18 and K-37).To analyze the clinical characteristics of HPV-negative and positive cervical cancer.Results:33 cases of cervical cancer with negative cytology were detected by tissue paraffin section and molecular pathology.The results of K-14 and K-18 kits were 13 negative and 9 of K-37 kits were negative.There were statistical differences in the first clinical manifestations between 9 patients with negative cervical cancer and 84 patients with positive cervical cancer in molecular pathology,the proportion of contact bleeding and irregular vaginal bleeding in negative group was smaller than that in positive group(3/9∶41/84,1/9∶33/84;χ2=12.889,P=0.006).There were statistical differences in FIGO stages at the time of treatment,the proportion of Ib2,IIa2,ⅢandⅣstages in negative group was higher than that in positive group(3/9∶13/84,1/9∶7/84,2/9∶0/84;χ2=12.786,P=0.021).There were statistical differences in pathological types,the proportion of adenocarcinoma in negative group was higher than that in positive group(3/9∶5/84;χ2=5.752,P=0.041).There were statistical differences in tumor infiltration depth among surgical patients,the proportion of early infiltration,infiltration to cervical external orifice and infiltration to uterine body in negative group was higher than that in positive group(2/7∶6/64,2/7∶14/64,3/7∶11/64;χ2=8.332,P=0.035).Conclusion:Theoretically,HPV-negative cervical cancer exists.Clinically,HPV negative cervical cancer has the characteristics of atypical initial clinical manifestations,late FIGO stage and large proportion of adenocarcinoma.