| Objective: To understand the changing trends and epidemiological characteristics of HPV-associated major cancer in Xinjiang,to reveal the HPV attribution scores of cervical and vaginal vulvar cancers in Xinjiang,and to explore the factors influencing the direct economic burden of patients first diagnosed and operated on for HPV-associated major cancer.Methods: A tertiary cancer hospital in Xinjiang was selected as the project site.HPV-associated cancer cases first diagnosed and treated in this hospital between 1 January2017 and 30 December 2021 were collected,and basic information,direct medical costs,information on disease risk factors,symptoms and stage at diagnosis were collected through a questionnaire.HPV attribution scores were calculated for cervical and vaginal vulvar cancers,with the numerator of HPV AF being the number of cases testing positive for HPV and the denominator being the total number of patients diagnosed with a cancer at that anatomical site.Factors influencing the direct economic burden of first admission and surgery for patients with cervical cancer and HPV-associated non-cervical site cancer were analysed using univariate and multifactorial analyses.Results: A total of 593 cases were included,including 234(39.46%)cases of cervical cancer,12(2.02%)cases of vaginal cancer,114(19.22%)cases of vulvar cancer,175(29.51%)cases of head and neck cancer(including 59 cases of oral cancer,29 cases of oropharyngeal cancer and 87 cases of laryngeal cancer),40(6.75%)cases of penile cancer and 18(3.04%)cases of anal cancer.The number of cases of penile cancer was 40(6.75%)and anal cancer 18(3.04%).HPV attributable risk analysis of cervical cancer and vaginal vulvar cancer in Xinjiang showed that the positive rate of HPV in cervical cancer patients was 87.18%,and the attributable risk of cervical cancer in different years was higher than 80%.The positive rate of HPV in patients with vaginal vulvar cancer was 29.37%.Except for 2021,when the positive rate of HPV in vaginal vulvar cancer was 33.33%,the positive rate of HPV in other years was between 25% and 30%.The group with the highest risk of HPV attribution was <30 years old.With the increase of age,the positive rate of HPV showed a downward trend,and the group with the least risk was ≥60 years old.The attributable risk analysis of vaginal vulvar cancer is the same as that of cervical cancer.With the increase of age,the positive rate of HPV shows a downward trend.The highest HPV positive rate was 87.80% for cervical cancer in married patients,and 35.00% for vaginal and vulvar cancer in divorced or widowed patients.The most common pathological types of cervical cancer and vulvar carcinoma were squamous cell carcinoma,and the positive rates of HPV in squamous cell carcinoma were 90.00% and 31.00%,respectively.HPV positive(OR=3.67,95%CI: 1.23-10.93),those aged 30～39 years(OR=7.82,95%CI: 1.06-57.80)and older than 60 years(OR=9.64,95%CI:1.23～75.28),longer hospital stay(OR=1.13,95%CI:1.07～1.21),adenocarcinoma(OR=4.20,95%CI:1.05～16.75)compared with squamous cell carcinoma would increase the direct economic burden of cervical cancer patients.Being married(OR=15.68,95%CI: 1.08-228.70)and having a long hospital stay(OR=1.08,95%CI: 1.05-1.12)increased the direct economic burden of patients with HPV-related tumors at noncervical sites.Farmers(OR=0.27,95%CI:0.09～0.79)and stage II(OR=0.31,95%CI:0.11～0.90)reduced the direct economic burden of patients with HPV-related cancer at non-cervical sites.Conclusion: The attributable fraction of cervical cancer and vaginal and vulvar cancer in Xinjiang were 87.18% and 29.37%,respectively.The attributive scores showed a decreasing trend with the increase of age.HPV infection,age 30-39 years and older than 60 years,longer hospital stay,pathological type adenocarcinoma will increase the direct economic burden of cervical cancer patients at the time of first diagnosis and treatment.Being staying in hospital for a long time increased the direct economic burden of first diagnosis and treatment of related non-cervical tumors,while being a farmer and having tumor stage Ⅱ reduced the direct economic burden. |
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