Prevalence and Genotype Distribution of Human Papillomavirus in Invasive Cervical Cancer, Cervical Intraepithelial Neoplasia, and Asymptomatic Women in Southeast China

Abstract

Cervical cancer is one of the leading causes of cancer-related deaths among women and it is caused by the human papillomavirus (HPV). High variation has been reported in the attribution of specific HPV genotypes to cervical neoplasia among various geographic regions. For effective control of cervical cancer through HPV vaccination, it is essential to estimate the cost-effectiveness of vaccination, to monitor the potential transition into other HPV genotypes, and to understand the distribution of specific HPV genotypes across a specific geographic region. In this study, the distribution of HPV genotypes was investigated in southeast China, from 2011 to 2016. The 12,816 cervical swabs collected from women (age 18-78 years, median 43.6 years) outpatients were analyzed. HPV prevalence among 12,816 cervical swabs analyzed was 22.3% (2,856/12,816). Among these positive cases, 2,216 had only one HPV genotype while 640 had multiple HPV genotypes. The cases with multiple types revealed 23 different HPV genotypes with the five most prevalent being HPV18 (18.2%), HPV52 (14.1%), HPV16 (11.9%), HPV58 (10.6%), and HPV33 (5.5%). The rates of HPV infection in patients with cervical inflammation, CIN-1, CIN-2, CIN-3, squamous carcinoma, and adenocarcinoma were 38.4%, 80.5%, 82.6%, 92.3%, 97.5%, and 93.4%, respectively. Four HPV genotypes, HPV18, HPV16, HPV52, and HPV58, were more prevalent in patients with CIN-2-CIN-3 and invasive cervical cancer. A comparison of HPV genotypes attribution to cervical cancer between southeast China and global incidences revealed distinct differences. Due to this unique prevalence, it is essential to streamline the vaccination development protocol prior to administering vaccines based on global data.

Figure 1

HPV pervasiveness. (a) Pervasiveness of HPV-positive specimens. (b) Single and multiple HPV infections. (c) Frequency of high-risk and low-risk HPV types of HPV-positive specimens. The total frequency of 4,008 surpassed the number of positive samples (2,856) since every single genotype was counted independently in multiple infections.

Figure 2

Distribution of HPV genotypes of the HPV-positive specimens. (a) High-risk HPV genotypes. (b) Low-risk genotypes.

Figure 3

Distribution of HPV genotypes in single (a) and multiple (b) HPV infections.

Figure 4

Relative distribution of HPV types of HPV-positive invasive cervical cancer and cervical intraepithelial neoplasia. (a) Relative distribution of HPV types of HPV-positive cervical squamous cell carcinoma (N = 326) and adenocarcinoma (N = 121). (b) Relative distribution of HPV types of HPV-positive cervical intraepithelial neoplasia (CIN) grade 1 (N =528), CIN-2 (N= 625), and CIN-3 (N =714). Patients with several identified HPV types are in each type and thus were counted more than once.