Efectividad del cribado de cáncer de cérvix mediante genotipado del virus del papiloma humano de alto riesgo. Estudio de cohortes multicéntrico en la China rural
DOI:
https://doi.org/10.23938/ASSN.1065Palabras clave:
Infección por Virus del Papiloma Humano, Cáncer de cuello uterino, Cribado, Zonas Rurales, ChinaResumen
Fundamento. El objetivo es evaluar la viabilidad del cribado de cáncer de cérvix mediante determinación del virus del papiloma humano (VPH) de alto riesgo (AR) en China rural.
Métodos. Se reclutaron mujeres de 21 a 64 años. La citología cervical se informó siguiendo la nomenclatura Bethesda 2001. La infección por VPH (VPH-AR, VPH-16, VPH-18 y otros 12 genotipos) se identificó mediante Cobas-4800. Algunos resultados exigieron la realización de colposcopia y biopsia. Los resultados primarios fueron la incidencia acumulada de neoplasia intraepitelial cervical de grado 2/3/superior (CIN2/3+) y su riesgo relativo (RR) al inicio y a los 36 meses de seguimiento.
Resultados. El estudio incluyó 9.218 mujeres; la edad media fue 45,15 años (DE: 8,74) y el 81% completó el seguimiento. Las lesiones citológicas (12,4%) más frecuentes fueron ASCUS (8,4%) y LSIL (2,2%). La infección por VPH-AR (16,3%) fue más prevalente por por VPH-16 que por VPH-18 (3 vs 1,5% ) y aumentó con la gravedad de las lesiones (ASCUS 29,8% vs HSIL 89,6%). Al inicio se realizaron 3,5% colposcopias, el 20% patológicas. A los 36 meses de seguimiento, la incidencia acumulada de CIN2+ y CIN3+ fue mayor en mujeres con VPH-AR positivo (16,9 vs 0,5% y 8,2 vs 0,2%). El RR de CIN2/3+ fue menor en mujeres con VPH-AR negativo que con citología negativa al inicio del estudio (0,4; IC95%: 0,3–0,4).
Conclusiones. El cribado de cáncer de cérvix mediante VPH-AR parece reducir significativamente el riesgo de CIN2/3+ respecto a la citología, por lo que podría ser un nuevo recurso de salud pública en China rural.
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