Costa Silvano, De Simone Pia, Venturoli Simona, Cricca Monica, Zerbini Maria L, Musiani Monica, Terzano Patrizia, Santini Donatella, Cristiani Paolo, Syrjänen Stina, Syrjänen Kari
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
Gynecol Oncol. 2003 Aug;90(2):358-65. doi: 10.1016/s0090-8258(03)00268-3.
The objective was to identify the factors, if any, that may predict long-term results of CIN treatment and HPV clearance/persistence after locally excisional therapy.
A series of 252 women with CIN lesions treated by conization were subjected to sequential HPV detection by repeated PCR during the prospective posttreatment follow-up. Factors predicting viral clearance during the follow-up (10.26 months) were elaborated using univariate and multivariate statistical techniques applied on epidemiological, clinical and biological data of the lesions.
Sensitivity of the PAP test in detecting high-grade lesions was 93.9%, and specificity 27.3%. Odds ratio for having CIN 3/Stage IA1 squamous cervical cancer in the cone with HSIL PAP test was 5.69; 77.8 and 22.2% residual disease were found among PCR-positive and -negative cases, respectively. HPV DNA was negative in 74/252 (29.8%) samples at the first PCR. Multivariate logistic regression analysis showed that HPV 16 was an independent explanatory factor for high-grade CIN (P = 0.0001). HPV clearance increased to 63.5% at completion of the follow-up, corresponding to the monthly clearance rate of 5.27%. In Kaplan-Meier analysis, the highly significant (P = 0.0001) predictors of HPV clearance/persistence were age, lesion grade in the biopsy, lesion grade in the cone, volume of the cone, length of active sexual life, and involvement of endocervical margin (P = 0.0013). In chi-square tests, high-risk HPV type (P = 0.001) was such a predictor. In multivariate (Cox) model, the significant independent predictors of HPV clearance were involved endocervical margin (P = 0.001), lesion grade in the cone (P = 0.004), high-grade lesion in the colposcopic biopsy (P = 0.023), age (P = 0.029), and HSIL in PAP smear (P = 0.029).
These data suggest that posttreatment follow-up should include both the PAP test and HPV detection techniques for early detection of any patients at increased risk for disease recurrence and progression, because of persistent oncogenic HPV types.
确定是否存在可预测CIN治疗长期效果以及局部切除治疗后HPV清除/持续感染情况的因素。
对252例接受锥切术治疗CIN病变的女性，在治疗后的前瞻性随访期间通过重复PCR进行连续HPV检测。运用单变量和多变量统计技术，对病变的流行病学、临床和生物学数据进行分析，以阐明随访期间（10.26个月）预测病毒清除的因素。
巴氏试验检测高级别病变的敏感性为93.9%，特异性为27.3%。HSIL巴氏试验结果的锥切标本中出现CIN 3/IA1期宫颈鳞癌的比值比为5.69；PCR阳性和阴性病例中分别发现77.8%和22.2%的残留病变。首次PCR时，252份样本中有74份（29.8%）HPV DNA呈阴性。多变量逻辑回归分析显示，HPV 16是高级别CIN的独立解释因素（P = 0.0001）。随访结束时HPV清除率增至63.5%，对应每月清除率为5.27%。在Kaplan-Meier分析中，HPV清除/持续感染的高度显著（P = 0.0001）预测因素为年龄、活检病变级别、锥切病变级别、锥切体积、活跃性生活时长以及宫颈管切缘受累情况（P = 0.0013）。在卡方检验中，高危HPV类型（P = 0.001）是这样一个预测因素。在多变量（Cox）模型中，HPV清除的显著独立预测因素为宫颈管切缘受累（P = 0.001）、锥切病变级别（P = 0.004）、阴道镜活检高级别病变（P = 0.023）、年龄（P = 0.029）以及巴氏涂片HSIL（P = 0.029）。
这些数据表明，治疗后的随访应同时包括巴氏试验和HPV检测技术，以便早期发现因致癌性HPV持续感染而疾病复发和进展风险增加的任何患者。
