Holcomb K, Matthews R P, Chapman J E, Abulafia O, Lee Y C, Borges A, Buhl A
Department of Obstetrics and Gynecology, State University of New York-Health Science Center at Brooklyn, Brooklyn, New York, 11203, USA.
Gynecol Oncol. 1999 Sep;74(3):428-31. doi: 10.1006/gyno.1999.5479.
The aim of this study was to evaluate the efficacy of cervical conization in the treatment of CIN in HIV-positive women.
Sixty-six HIV-positive women treated with cervical conization for CIN were stratified into four groups based on surgical margin and endocervical curetting (ECC) status (group 1: -margin/-ECC, group 2: +margin/-ECC, group 3: +margin/+ECC, group 4: -margin/+ECC). The rate of histologically proven recurrent CIN was calculated for each group and compared using chi(2) analysis. The effect of +margins, +ECC, degree of dysplasia, and CD4 count on the risk of recurrence was determined by logistic regression.
Forty-nine percent of patients with negative margins and negative ECC experienced recurrence, most within 36 months. There was no significant difference in recurrence rate for patients with positive margins (69.2%, P = 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%, P = 0.41) when compared to patients with complete excision of dysplasia. No significant difference in the mean CD4 count of patients with and without recurrent dysplasia (316 vs. 390 cells/mm3, P = 0.37) was observed. Logistic regression showed only degree of dysplasia in the cone specimen to have a marginally significant linear relationship with recurrence.
Cervical conization is not an effective method for eradicating CIN in HIV-positive women. Most patients will recur despite complete excision of dysplasia. Surgical margin status, ECC status, and CD4 count appear to have no effect on recurrence rate. Although multiple procedures were necessary in some patients, cone biopsy was effective in preventing progression to invasive cervical cancer in all cases.
本研究旨在评估宫颈锥切术治疗HIV阳性女性宫颈上皮内瘤变（CIN）的疗效。
66例因CIN接受宫颈锥切术治疗的HIV阳性女性，根据手术切缘和宫颈管刮术（ECC）情况分为四组（第1组：切缘阴性/ECC阴性，第2组：切缘阳性/ECC阴性，第3组：切缘阳性/ECC阳性，第4组：切缘阴性/ECC阳性）。计算每组经组织学证实的CIN复发率，并采用卡方分析进行比较。通过逻辑回归确定切缘阳性、ECC阳性、发育异常程度和CD4细胞计数对复发风险的影响。
切缘阴性且ECC阴性的患者中有49%出现复发，多数在36个月内复发。与发育异常完全切除的患者相比，切缘阳性（69.2%，P = 0.19）、ECC阳性（50%，P = 0.97）或切缘和ECC均阳性（66.7%，P = 0.41）的患者复发率无显著差异。复发和未复发发育异常的患者平均CD4细胞计数无显著差异（316对390个细胞/mm³，P = 0.37）。逻辑回归显示，仅锥切标本中的发育异常程度与复发有微弱的显著线性关系。
宫颈锥切术并非根除HIV阳性女性CIN的有效方法。尽管发育异常已完全切除，但大多数患者仍会复发。手术切缘状态、ECC状态和CD4细胞计数似乎对复发率无影响。虽然部分患者需要多次手术，但锥切活检在所有病例中均有效预防了进展为浸润性宫颈癌。
