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Open AccessArticle

Multistate Markov Model to Predict the Prognosis of High-Risk Human Papillomavirus-Related Cervical Lesions

1
Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
2
Gynecology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo 113-8677, Japan
3
Graduate School of Economics, The University of Tokyo, Tokyo 113-0033, Japan
4
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo 113-8677, Japan
5
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
6
Department of Obstetrics and Gynecology, School of Medicine, Nihon University, Tokyo 173-8610, Japan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(2), 270; https://doi.org/10.3390/cancers12020270 (registering DOI)
Received: 19 November 2019 / Revised: 10 January 2020 / Accepted: 20 January 2020 / Published: 22 January 2020
(This article belongs to the Special Issue Human Papillomavirus and Cancers)
Cervical intraepithelial neoplasia (CIN) has a natural history of bidirectional transition between different states. Therefore, conventional statistical models assuming a unidirectional disease progression may oversimplify CIN fate. We applied a continuous-time multistate Markov model to predict this CIN fate by addressing the probability of transitions between multiple states according to the genotypes of high-risk human papillomavirus (HPV). This retrospective cohort comprised 6022 observations in 737 patients (195 normal, 259 CIN1, and 283 CIN2 patients at the time of entry in the cohort). Patients were followed up or treated at the University of Tokyo Hospital between 2008 and 2015. Our model captured the prevalence trend satisfactory, particularly for up to two years. The estimated probabilities for 2-year transition to CIN3 or more were the highest in HPV 16-positive patients (13%, 30%, and 42% from normal, CIN1, and CIN2, respectively) compared with those in the other genotype-positive patients (3.1–9.6%, 7.6–16%, and 21–32% from normal, CIN1, and CIN2, respectively). Approximately 40% of HPV 52- or 58-related CINs remained at CIN1 and CIN2. The Markov model highlights the differences in transition and progression patterns between high-risk HPV-related CINs. HPV genotype-based management may be desirable for patients with cervical lesions. View Full-Text
Keywords: cervical intraepithelial neoplasia; high-risk human papillomavirus; multistate Markov model; retrospective cohort study; survival analysis cervical intraepithelial neoplasia; high-risk human papillomavirus; multistate Markov model; retrospective cohort study; survival analysis
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Taguchi, A.; Hara, K.; Tomio, J.; Kawana, K.; Tanaka, T.; Baba, S.; Kawata, A.; Eguchi, S.; Tsuruga, T.; Mori, M.; Adachi, K.; Nagamatsu, T.; Oda, K.; Yasugi, T.; Osuga, Y.; Fujii, T. Multistate Markov Model to Predict the Prognosis of High-Risk Human Papillomavirus-Related Cervical Lesions. Cancers 2020, 12, 270.

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