???????????: ???????18??????Pooled??

1
??????????????????18??????Pooled??
??? ???????????????????????2010-5-22,??
2
????

• ????????????
• ???????
• ????
• ????

3
??????????

• ?????,????????????????,????500,000 ?????273,000
  ????,gt80 ??????
• ??????,?????????????,????????????,????????????????
  ???
• ?????????

1990-92?????(???)
2004-05?????(???)
4
???????????

• ??????????????????,???????????????????
• 2004??????????????????????????????????????
• ??????????????????????????????????,??2006?6?????
  2008????43??(????1??)?????????2000-3500??
• ??????????????????????? 2009-11???????????,????
  221?,1000??

5
???. Vol 374358. August 1, 2009
Editorial Womens health in rural China
The new government-sponsored program is a step
towards provision of universal breast and
cervical cancer screening nationwide, although
with an estimated 500 million women in rural
China the public health challenge is substantial.
This is the first time Chinas Government has
proposed to gradually widen access to public
health services so that women in rural China are
included. This admirable step needs to be
followed by development of more appropriate
health-care policies to achieve access to
health-care services for all. The success of
this health-care program will need to be
evaluated carefully over a sustained period, and
could provide a good model for other
middle-income countries to follow.
6
????????????
?????????
7
????????????

• Pap smear ?1941??????????,?????????????
• ??????????????
• ?????????
• ?????????????????????????????

8
???????(LBC)
????????????????????,????????????????????????
9
?????????HPV????(HC2)
???????13????HPV,??FDA?2003?3?31?????????????????
????????????????????????,??????
10
??/???????(VIA/VILI)
???????????,?????????,??????????,WHO?????????????
??????,????????????????????
11
?????????
1. ???
2. ??? ???????????????????????
12
???????

• Pooled ???????
• 1999-2008?????
• 18 ???????????
• (SPOCCS,WHO??,START)
• ????????
• ?????
• 31,090?
• 17-59?
• 5?????9????(10?)

13
Location of Counties/cities
Uygur Minority
14
????
????
10,000????VIA ?????VILI(7???)
13,000???HC2?? (5 ???)
????? (???????)
?? (????)
??30,000?17-59???? HC2, VIA,?LBC, ? (18 ???)
?? (????)
??
?? 31,090 ???
?SPOCCSI (n1,997) ???,????????????6???(n11,408
),???????????????????????? (?.??????care HPV)?
15
??-??????
???? ???? ???? ???? ???? ???? N
??? ??? 39.786.95
lt35 lt35 lt35 6,107 6,107 6,107 6,107 19.60
35-49 35-49 35-49 22,779 22,779 22,779 22,779 73.30
50 50 50 2,204 2,204 2,204 2,204 7.10
?? ??
?? ?? ?? 27,554 27,554 27,554 27,554 88.60
?? ?? ?? 3,536 3,536 3,536 3,536 11.40
???? ????
?? ?? ?? ?? ?? 3,055 3,055 9.80
?? ?? ?? ?? 9,589 9,589 9,589 30.80
?? 14,199 ?? 14,199 ?? 14,199 ?? 14,199 ?? 14,199 ?? 14,199 ?? 14,199 45.70
????? 4,247 ????? 4,247 ????? 4,247 ????? 4,247 ????? 4,247 ????? 4,247 ????? 4,247 13.70
??? 0-17 0-17 0-17 0-17 0-17 0-17 2.891.42
??? 0-14 0-14 0-14 0-14 0-14 0-14 2.231.03
16
????HC2???pooled???????
CIN 2 ???
pooled??? 0.86 (0.85-0.86). Chi-squared 714.7,
df17, plt0.0001
pooled??? 0.96 (0.95-0.97). Chi-squared 26.4,
df17, p.0.07
17
????????????????HC2??
??? ???? ???? ???? ???? ???? ???? ???? ????
??? ??? ??? AUC ?????? ??? ??? AUC ??????
??? , (95 CI) , (95 CI) (95CI) , (95 CI) , (95 CI) , (95 CI) (95CI) , (95 CI)
1 96.3 85.9 0.911 16.7 86.2 80.9 0.836 21.8
1 (94.9-97.4) (85.5-86.3) (0.904-0.919) (16.2-17.1) (83.0-89.0) (80.2-81.6) (0.818-0.853) (21.1-22.5)
2 94.2 88.4 0.913 14.1 83.3 84.1 0.837 18.5
2 (92.5-95.5) (88.0-88.8) (0.904-0.922) (13.8-14.5) (79.8-86.3) (83.5-84.7) (0.818-0.856) (17.9-19.2)
3 92.0 89.5 0.908 13.0 79.6 85.7 0.826 16.9
3 (90.1-93.6) (89.1-89.8) (0.897-0.918) (12.7-13.4) (75.9-82.8) (85.0-86.3) (0.806-0.847) (16.3-17.5)
4 90.9 90.0 0.904 12.5 77.4 86.7 0.82 15.8
4 (88.8-92.6) (89.7-90.4) (0.894-0.915) (12.1-12.9) (73.6-80.8) (86.1-87.3) (0.799-0.842) (15.2-16.4)
10 87.0 91.8 0.894 10.7 67 89.6 0.783 12.6
10 (84.7-89.0) (91.4-92.1) (0.881-0.906) (10.3-11.0) (62.8-70.9) (89.0-90.1) (0.758-0.807) (12.1-13.2)
20 82.0 93.1 0.876 9.2 58.7 91.4 0.751 10.6
20 (79.5-84.4) (92.8-93.4) (0.861-0.890) (8.9-9.6) (54.4-62.9) (90.9-91.9) (0.724-0.777) (10.1-11.1)
18
HC2???ROC??????????? ?CIN 2???
19
VIA?pooled???????
CIN 2 ???
pooled??? 0.91 (0.90-0.91) Chi-squared 1118.88,
df17, plt0.0001
pooled??? 0.48 (0.45-0.51) Chi-squared 59.26,
df17, plt0.0001
20
VIA?VIA/VILI???
CIN 2 ???
21
ROC??
22
??????????
23
?????????????
????   lt35y 35-49 50 ??
????HC2     Sensitivity 97.1 (91.9-99.0) 96.0 (94.4-97.2) 100.0 (92.9-100.0) 96.3 (94.9-97.4)
????HC2     Specificity 89.2 (88.3-89.9) 84.9 (84.4-85.3) 87.4 (85.9-88.7) 85.9 (85.5-86.3)
????HC2     PPV 14.2 (11.8-17.0) 18.7 (17.5-19.9) 15.8 (12.2-20.3) 17.9 (16.8-19.0)
????HC2     NPV 99.9 (99.8-100) 99.8 (99.8-99.9) 100.0 (99.8-100.0) 99.9 (99.8-99.9)
VIA       Sensitivity 52.7 (43.4-61.9) 49.1 (45.6-52.6) 24 .0 (13.7-37.2) 48.2 (45.0-51.4)
VIA       Specificity 88.5 (87.6-89.3) 90.7 (90.3-91.0) 95.1 (94.1-96.0) 90.5 (90.2-90.9)
VIA       PPV 8.0 (6.2-10.2) 16.0 (14.6-17.5) 10.4 (5.8-17.1) 14.0 (12.9-15.3)
VIA       NPV 99.0 (98.7-99.2) 98.0 (97.8-98.2) 98.1 (97.5-98.7) 98.2 (98.0-98.4)
?? 30-35 ??66, 25-29??18.4, 15-24 ?16
24
???????????
25
??(1)

• VIA???????,??????,??VILI?????????????,VIA/VILI?50?
  ??????????
• VIA?????????,???????????HPV??????????????,????????
  ?????
• ?????????????,?????,???????????,????????

26
??(2)

• HPV DNA??(HC-2)???????????????,????,???????????
• HPV DNA????????????, 35???????HPV?????????
• ????HPV?????????????HPV??,?????????
• HPV DNA?????????2.0pg/mL?,?????????,??????????

27
????????

• ?HPV??????????????????,???????????????????????
• ???/???????????,???????careHPV????(Se90.0,Sp84
  .2),????hc-2 ?????
• HPV??????????????????????????????????????????????
  ?

Qiao YL, Sellors J et al Lancet Oncology 2008,
9(10)929-36.
28
??
?????????????????????????????????????????????????
???????????????????????