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Aoki ES, Saika K, Kiguchi K, Morisada T, Aoki D. Validation of HPV triage in cytology-based cervical cancer screening for ASC-US cases using Japanese data. J Gynecol Oncol 2023; 34:e14. [PMID: 36424706 PMCID: PMC9995872 DOI: 10.3802/jgo.2023.34.e14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE In Japan, cervical cancer screening consists of a cytology examination performed once every 2 years. We verified whether the risk of cervical intraepithelial neoplasia (CIN) 3 disease or higher (CIN3+) was equivalent to that of cytology negative cases (negative for intraepithelial lesion or malignancy [NILM]) for patients with a cytological diagnosis of "atypical squamous cells of undetermined significance (ASC-US)" who tested negative for human papillomavirus (HPV). METHODS Data from a total of 22,925 cases who had undergone cervical cancer screening at least twice or who had completed follow-up examinations after cervical screening at a single facility between April 2013 and April 2018 were analyzed. The cumulative incidence of CIN3+ was calculated for each category of initial cytology finding and HPV result (NILM, > ASC-US, ASC-US/HPV (unknown), ASC-US/HPV+, and ASC-US/HPV-). The statistical analysis was conducted using the Cox proportional hazards model. RESULTS The hazard ratio for the cumulative incidence of CIN3+ in 2 years relative to that for NILM cases was 2.7 (95% confidence interval=1.0-7.8) for > ASC-US cases, 0.5 (0.1-1.7) for ASC-US/HPV (unknown), 0.8 (0.3-2.4) for ASC-US/HPV+ cases, and 0.3 (0.1-1.0) for ASC-US/HPV- cases. CONCLUSION Because the cumulative incidence of CIN3+ at 2 years for the ASC-US/HPV- cases was sufficiently low, compared with that of the NILM cases, we considered it reasonable and safe to perform HPV triage for ASC-US cases and to allow HPV-negative cases to return for their next screening in 2 years, which is the same follow-up schedule as that for NILM cases.
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Affiliation(s)
- Eiko Saitoh Aoki
- Preventive Medicine Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Obstetrics, Tokyo Health Service Association, Tokyo, Japan.
| | - Kumiko Saika
- Saku Central Hospital Advanced Care Center, Nagano Prefectural Federation of Agricultural Cooperatives for Health and Welfare, Nagano, Japan
- Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Kazushige Kiguchi
- Department of Obstetrics, Tokyo Health Service Association, Tokyo, Japan
- Koukan Clinic, Nippon Koukan Hospital, Kanagawa, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Jang H, Yoon JS, Park SY, Lee HA, Jang MJ, Kim SU, Sinn DH, Seo YS, Kim HY, Kim SE, Jun DW, Yoon EL, Sohn JH, Ahn SB, Shim JJ, Jeong SW, Cho YK, Kim HS, Nam JY, Lee YB, Kim YJ, Yoon JH, Zoulim F, Lampertico P, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Papatheodoridis GV, Lee JH. Impact of HBeAg on Hepatocellular Carcinoma Risk During Oral Antiviral Treatment in Patients With Chronic Hepatitis B. Clin Gastroenterol Hepatol 2022; 20:1343-1353.e16. [PMID: 34500103 DOI: 10.1016/j.cgh.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Antiviral treatment from hepatitis B envelope antigen (HBeAg)-positive status may attenuate the integration of hepatitis B virus DNA into the host genome causing hepatocellular carcinoma (HCC). We investigated the impact of HBeAg status at the onset of antiviral treatment on the risk of HCC. METHODS The incidence of HCC was evaluated in Korean patients with chronic hepatitis B who started entecavir or tenofovir in either HBeAg-positive or HBeAg-negative phase. The results in the Korean cohort were validated in a Caucasian PAGE-B cohort. RESULTS A total of 9143 Korean patients (mean age, 49.2 years) were included: 49.1% were HBeAg-positive and 49.2% had cirrhosis. During follow-up (median, 5.1 years), 916 patients (10.0%) developed HCC. Baseline HBeAg positivity was not associated with the risk of HCC in the entire cohort or cirrhotic subcohort. However, in the non-cirrhotic subcohort, HBeAg positivity was independently associated with a lower risk of HCC in multivariable (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.26-0.66), propensity score-matching (aHR, 0.46; 95% CI, 0.28-0.76), and inverse probability weighting analyses (aHR, 0.44; 95% CI, 0.28-0.70). In the Caucasian cohort (n = 719; mean age, 51.8 years; HBeAg-positive, 20.3%; cirrhosis, 34.8%), HBeAg-positivity was not associated with the risk of HCC either in the entire cohort or cirrhotic subcohort. In the non-cirrhotic subcohort, none of the HBeAg-positive group developed HCC, although the difference failed to reach statistical significance (aHR, 0.21; 95% CI, 0.00-1.67). CONCLUSIONS This multinational cohort study implies that HBeAg positivity at the onset of antiviral treatment seems to be an independent factor associated with a lower risk of HCC in patients with chronic hepatitis B without cirrhosis, but not in those with cirrhosis.
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Affiliation(s)
- Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabien Zoulim
- Cancer Research Centre of Lyon, INSERM U, Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- The Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry LA Janssen
- Liver Clinic, Toronto Western and General Hospital, University Health Network, Toronto, ON, Canada
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Dharmarajan SH, Schaubel DE, Saran R. Evaluating center performance in the competing risks setting: Application to outcomes of wait-listed end-stage renal disease patients. Biometrics 2017; 74:289-299. [PMID: 28682445 DOI: 10.1111/biom.12739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/27/2022]
Abstract
It is often of interest to compare centers or healthcare providers on quality of care delivered. We consider the setting where evaluation of center performance on multiple competing events is of interest. We propose estimating center effects through cause-specific proportional hazards frailty models that allow correlation among a center's cause-specific effects. Estimation of our model proceeds via penalized partial likelihood and is implemented in R. To evaluate center performance, we also propose a directly standardized excess cumulative incidence (ECI) measure. Therefore, based on our proposed methods, practitioners can evaluate centers either through the cause-specific hazards or the cumulative incidence functions. We demonstrate, through simulations, the advantages of the proposed methods to detect outlying centers, by comparing the proposed methods and existing methods which assume uncorrelated random center effects. In addition, we develop a Correlation Score Test to test the null hypothesis that the competing event processes within a center are correlated. Using data from the Scientific Registry of Transplant Recipients, we apply our method to evaluate the performance of Organ Procurement Organizations on two competing risks: (i) receipt of a kidney transplant and (ii) death on the wait-list.
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Affiliation(s)
- Sai H Dharmarajan
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Douglas E Schaubel
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Rajiv Saran
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
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Dong L, Feng RM, Zhang L, Xu XQ, Zhao XL, Wang MZ, Qiao YL, Zhao FH. Prospective comparison of hybrid capture 2 and SPF₁₀-LiPA for carcinogenic human papillomavirus detection and risk prediction of cervical cancer: a population-based cohort study in China. J Gynecol Oncol 2017; 28:e66. [PMID: 28657227 PMCID: PMC5540725 DOI: 10.3802/jgo.2017.28.e66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/09/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the extent of the cross-reactivity of hybrid capture 2 (HC2) assay and evaluate the potential effect of cross-reactivity on the long-term risk for cervical cancer and precancers. Methods Based on the Shanxi Province Cervical Cancer Screening Study-I (SPOCCS-I) cohort from 2005 to 2014 in Shanxi, China, SPF10-line probe assay (LiPA) was performed in all 598 HC2 positive and 300 random-selected HC2 negative cervical specimens. Ten-year cumulative incidence rate (CIR) of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) of these two tests was evaluated using Kaplan-Meier methods. Possible human papillomavirus (HPV) types to be cross-reacted by HC2 were also analyzed. Results The overall agreement between HC2 and SPF10-LiPA for detecting carcinogenic HPV was 73.27%. The highest 10-year cumulative risk of CIN2+ was observed in both HC2 positive and LiPA-carcinogenic HPV positive women (25.70%; 95% confidence interval [CI]=23.55%–27.91%), followed by HC2 positive but LiPA-non-carcinogenic HPV positive women (9.97%; 95% CI=8.57%–11.50%), HC2 negative but LiPA-carcinogenic HPV positive (2.56%; 95% CI=2.44%–2.70%) and HC2 positive but LiPA-HPV negative (1.85%; 95% CI=1.78%–1.92%) women. The proportion of cross-reactivity of HC2 with untargeted carcinogenic types was 8.9%, most of which were attributable to HPV26, 73, 82, 69, 71, 53, 11, 43, and 54. Conclusion The noticeable high risk of CIN2+ in women infected with cross-reacted non-carcinogenic HPV and low risk in those with miss-to-detective carcinogenic HPV supported an overall good clinical performance of HC2 for a general cervical cancer screening.
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Affiliation(s)
- Li Dong
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Mei Feng
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Qian Xu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Lian Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - You Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Yip J, Zeig-Owens R, Webber MP, Kablanian A, Hall CB, Vossbrinck M, Liu X, Weakley J, Schwartz T, Kelly KJ, Prezant DJ. World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers. Occup Environ Med 2015; 73:13-20. [PMID: 25876606 DOI: 10.1136/oemed-2014-102601] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/21/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the health burden among Fire Department of the City of New York (FDNY) emergency medical service (EMS) workers and examine its association with work at the World Trade Center (WTC) disaster site. METHODS In this observational cohort study, we used FDNY physician diagnoses to estimate the cumulative incidence of physical health conditions including rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive airways disease (OAD) and cancer among EMS workers and demographically similar firefighters who were active on 11 September 2001 (9/11). Validated screening instruments were used to estimate the prevalence of probable post-traumatic stress disorder (PTSD), probable depression and probable harmful alcohol use. We also analysed the association between health conditions and WTC-exposure. RESULTS Among 2281 EMS workers, the 12-year post-9/11 cumulative incidence (11 September 2001 to 31 December 2013) of rhinosinusitis was 10.6%; GERD 12.1%; OAD 11.8%; cancer 3.1%. The prevalence of probable PTSD up to 12 years after exposure was 7%; probable depression 16.7%; and probable harmful alcohol use 3%. Compared with unexposed, EMS workers who arrived earliest at the site had higher adjusted relative risks (aRR) for most conditions, including rhinosinusitis (aRR=3.7; 95% CI 2.2 to 6.0); GERD (aRR=3.8; 95% CI 2.4 to 6.1); OAD (aRR=2.4: 95% CI 1.7 to 3.6); probable PTSD (aRR=7.0; 95% CI 3.6 to 13.5); and, probable depression (aRR=2.3; 95% CI 1.6 to 3.1). CONCLUSIONS In this 12-year study, we documented a high burden of health conditions associated with WTC-exposure among FDNY EMS workers. These findings underscore the importance of continued monitoring and treatment of this workforce.
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Affiliation(s)
- Jennifer Yip
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, USA Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Kablanian
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, USA Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madeline Vossbrinck
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Xiaoxue Liu
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Jessica Weakley
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Theresa Schwartz
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Kerry J Kelly
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA Department of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Bronx, New York, USA
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