Bodner Klaus, Bodner-Adler Barbara, Wierrani Franz, Kimberger Oliver, Denk Christine, Grünberger Werner
Department of Gynecology and Obstetrics, Hospital Rudolfstiftung, A-1030 Vienna, Juchgasse 25, Austria.
Anticancer Res. 2002 Nov-Dec;22(6B):3733-6.
High-risk human papillomavirus infection plays a predominant role in the pathogenesis of preinvasive and invasive cervical cancer. One of the recognized treatments of cervical intraepithelial neoplasia is conization. The aim of this study was to evaluate if cold-knife conization is sufficient to eliminate cervical intraepithelial neoplasia and the associated high-risk HPV infection.
Thirty-seven high-risk HPV-positive women who underwent cold-knife conization entered this study. The cervical sampling for HPV DNA was performed using the Digene cervical sampler. Smears were taken immediately before and 3 months after conization and the patients were followed-up for 2 years.
High-risk HPV was identified in all 37 patients before conization. In 4 out of 37 patients a coincidence of low/intermediate and high-risk HPV types was present. A CIN II was detected in 5 out of 37, a CIN III in 25 out of 37 and a carcinoma in situ in 7 out of 37 cases. Follow-up at three months revealed that HPV was eradicated by conization in 73%. Patients with persistent HPV infection tended to be older compared to patients with eliminated HPV infection (mean: 34 vs. 36 years; p = 0.25) and showed a higher rate of severe dysplasia (p = 0.07). A high HPV prevalence among patients with positive resection margins and/or recurrence disease was detected (83% and 100%, respectively). A statistically significant higher rate of positive margins and recurrences was observed in patients with persistent compared to patients with eliminated HPV infection (50% vs. 4%. p = 0.001 and 30% vs. 0%, p = 0.003).
The data of the present study demonstrated that a high-risk HPV infection is successfully eliminated by conization in most cases. A high HPV prevalence in patients who had positive cone margins and/or disease recurrence was observed. Patients with persisting HPV infection after conization show statistically significant higher rates of positive resection margins and are at increased risk of disease recurrence. HPV testing seems to be, therefore, a valuable tool to monitor the therapeutic results of conization and to discriminate patients who have a higher risk of disease recurrence.
高危型人乳头瘤病毒感染在宫颈上皮内瘤变及浸润性宫颈癌的发病机制中起主要作用。宫颈上皮内瘤变公认的治疗方法之一是锥切术。本研究的目的是评估冷刀锥切术是否足以消除宫颈上皮内瘤变及相关的高危型人乳头瘤病毒感染。
37例接受冷刀锥切术的高危型人乳头瘤病毒阳性女性进入本研究。使用Digene宫颈采样器进行人乳头瘤病毒DNA的宫颈采样。在锥切术前及术后3个月立即进行涂片检查，并对患者进行2年的随访。
37例患者在锥切术前均检测到高危型人乳头瘤病毒。37例患者中有4例同时存在低/中危型和高危型人乳头瘤病毒。37例中有5例检测到CIN II，25例检测到CIN III，7例检测到原位癌。3个月的随访显示，73%的患者通过锥切术清除了人乳头瘤病毒。与清除人乳头瘤病毒感染的患者相比，持续感染人乳头瘤病毒的患者年龄偏大（平均年龄：34岁对36岁；p = 0.25），且重度发育异常的发生率更高（p = 0.07）。切缘阳性和/或疾病复发的患者中人乳头瘤病毒感染率较高（分别为83%和100%）。与清除人乳头瘤病毒感染的患者相比，持续感染人乳头瘤病毒的患者切缘阳性率和复发率在统计学上显著更高（50%对4%，p = 0.001；30%对0%，p = 0.003）。
本研究数据表明，大多数情况下锥切术可成功清除高危型人乳头瘤病毒感染。观察到锥切缘阳性和/或疾病复发的患者中人乳头瘤病毒感染率较高。锥切术后持续感染人乳头瘤病毒的患者切缘阳性率在统计学上显著更高，且疾病复发风险增加。因此，人乳头瘤病毒检测似乎是监测锥切术治疗效果及鉴别疾病复发风险较高患者的有价值工具。
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