Human papillomavirus genotypes and the risk factors associated with multicentric intraepithelial lesions of the lower genital tract: a retrospective study

Abstract

Background Multicentric intraepithelial lesions of the lower genital tract (multicentric lesions) were defined as intraepithelial lesions of two or three sites within cervix, vagina, and vulva occurring synchronously or sequentially. The characteristics of multicentric lesions has been poorly understood. This study aimed to evaluate the risk factors for multicentric lesions, including specific HPV genotypes. Methods A retrospective case-control study was performed involving patients histologically diagnosed with multicentric lesions between January 2018 and October 2019. Controls were patients histologically diagnosed with single cervical intraepithelial neoplasia (CIN) and admitted during the same period. Univariable and multivariable analyses were used to assess the risk factors for multicentric lesions. Results Of 307 patients with multicentric lesions, the median age was 50 years (interquartile range: 43–55.5), and they were older than patients with single CIN (median age: 43 years, interquartile range: 36–50). In the multicentric lesion group, the proportions of cytologic abnormalities, HPV positivity, and multiple HPV infections were 68.9, 97.0, and 36.5%, respectively. In the multivariable analysis, menopause, a history of malignant tumors beyond the lower genital tract and multiple HPV infections were associated with the incidence of multicentric lesions (Odd ratio (OR) = 3.14, 95% confidence interval (CI) 2.24–4.41; OR = 9.58, 95% CI 1.02–89.84; OR = 1.47, 95% CI 1.03–2.10). The common HPV genotypes were HPV16, HPV53, HPV58, HPV52, HPV51, HPV56 and HPV18 in patients with multicentric lesions. The proportion of HPV16 infection was higher in high-grade lesions group than that in low-grade lesions group (OR = 2.54, 95% CI 1.34–4.83). The OR for multicentric lesions, adjusted for menopause, smoking, gravidity, parity, a history of malignant tumor beyond the lower genital tract and multiple HPV infection, was 1.97 (95% CI 1.04–3.75) in patients with HPV51 infection. Conclusions Multicentric lesions were associated with menopause, a history of malignant tumors and multiple HPV infections. HPV16 was the most common genotype, especially in high grade multicentric lesions and HPV51 infection was found to be a risk factor for detecting multicentric lesions.

Distribution of HPV Subtypes in Diverse Anogenital and Oral Samples from Women and Correlation of Infections with Neoplasia of the Cervix

“…In our study, comparable percentages of HPV 53 could be identified in HSIL with 8.3%, whereas no HPV 53 was found in LSIL, but 8.3% HPV 53 in CC. Other studies also described frequent detection of the subtype HPV 53 [26,29,30]. Furthermore, HPV 53 is described to occur more likely in multiple infections together with other types [26].…”

High-grade cervical intraepithelial neoplasia co-existing with vaginal intraepithelial neoplasia increased the risk of persistent human papillomavirus infection and residual/recurrent disease after LEEP

“…In the present study, after adjusting for potential confounding effects, such as age, multiple HPV infections, types of transformation zone, margin status, and preoperative HPV16/18 infection, co-existent CIN2/3 and VaIN had a higher tendency to harbor a persistent HR-HPV infection. This may due to the possible pathogenesis of multicentric lesions in the lower genital tract associated with speci c HPV genotypes infection in the cervix and vagina respectively [25]. Therefore, women suffering from co-existent CIN2/3 and VaIN should be closely followed up in the post-treatment period.…”

Multicentricity and the Risk of Recurrence/Persistence After Laser Vaporization for High-Grade Vulvar and Vaginal Intraepithelial Neoplasia

“…Although the concept of multicentric lower genital tract disease is generally accepted, there are some variations or inconsistencies regarding the definition of multicentricity. Several previous studies have defined multicentricity as intraepithelial lesions of two or three sites in lower genital tract, excluding invasive lesions [ 4 , 7 , 14 , 16 , 18 ]. Other research has included any grade of IN or invasive lesions [ 17 , 22 , 25 ].…”