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https://observatorio.fm.usp.br/handle/OPI/1626
Title: | Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the *NIS-LAMS** cohort |
Authors: | SYRJANEN, K.; SHABALOVA, I.; SARIAN, L.; NAUD, P.; LONGATTO-FILHO, A.; DERCHAIN, S.; KOZACHENKO, V.; ZAKHARCHENKO, S.; ROTELI-MARTINS, C.; NEROVJNA, R.; KLJUKINA, L.; TATTI, S.; BRANOVSKAJA, M.; BRANCA, M.; GRUNJBERGA, V.; ERZEN, M.; JUSCHENKO, A.; HAMMES, L. Serpa; PODISTOV, J.; COSTA, S.; SYRJANEN, S. |
Citation: | EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY, v.33, n.4, p.341-352, 2012 |
Abstract: | Background: The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these compet ng events have not been previously assessed using competing-risks regression models. Objectives: To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariaies associated with these competing events. Study Design and Methods: Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114). Results: In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance of ASCUS+Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective. Conclusions: Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - LIM/14 |
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