Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Korea.
Department of Obstetrics and Gynecology, Gachon Medical College, Gil Medical Center, Inchon, Korea.
Int J Cancer. 2010 Apr 15;126(8):1903-1909. doi: 10.1002/ijc.24794.
The natural history of high-risk human papillomavirus (HRHPV) infection after successful treatment of cervical intraepithelial neoplasia (CIN) is not well known. This study was performed to evaluate the rate and pattern of HRHPV infection clearance after successful conization for CIN and to analyze factors associated with such clearance. A total of 287 patients who underwent loop electrosurgical excision procedures (LEEP) owing to HRHPV-associated CIN were included. All patients had negative resection margins on LEEP specimens and underwent HPV testing with the hybrid capture II system at 3-, 6-, 9-, 12-, 18- and 24-month follow-up visits after LEEP. Persistent HPV infections were detected in 45.6%, 14.3%, 6.3%, 2.2%, 1.5% and 1.1% of patients at 3, 6, 9, 12, 18 and 24 months after LEEP, respectively. Clearance rates did not differ by age, parity or severity of cervical lesion. However, clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC before LEEP (p = 0.040). During 2 years of follow-up after LEEP, 24 patients had recurrent disease revealed by biopsy. The odds ratios for recurrent disease in patients with persistent HRHPV infection increased gradually from 5.17 at the 3-month follow-up visit to 12.54, 15.69 and 25.90 at 6-, 9-, 12- and 24-month follow-up visits, respectively. We conclude that HRHPV infection cleared gradually in most patients within 6 months of treatment. Clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC. Persistent HPV infection was a significant positive predictor of recurrence.
高危型人乳头瘤病毒（HRHPV）感染在成功治疗宫颈上皮内瘤变（CIN）后的自然史尚不清楚。本研究旨在评估 CIN 锥切术后 HRHPV 感染清除率及其相关因素。共纳入 287 例因 HRHPV 相关 CIN 行环形电切术（LEEP）的患者。所有患者的 LEEP 标本切缘均为阴性，并在 LEEP 后 3、6、9、12、18 和 24 个月时采用杂交捕获二代系统进行 HPV 检测。LEEP 后 3、6、9、12、18 和 24 个月时，分别有 45.6%、14.3%、6.3%、2.2%、1.5%和 1.1%的患者持续存在 HPV 感染。HPV DNA 载量>500 RLU/PC 的患者在 LEEP 前的清除率显著较慢（p=0.040）。LEEP 后 2 年的随访中，24 例患者经活检证实复发。持续 HRHPV 感染患者的复发病例比值比（OR）从 LEEP 后 3 个月的 5.17 逐渐增加至 6 个月时的 12.54、9 个月时的 15.69、12 个月时的 25.90 和 24 个月时的 25.90。我们的结论是，大多数患者在治疗后 6 个月内 HRHPV 感染逐渐清除。HPV DNA 载量>500 RLU/PC 的患者清除率显著较慢。持续性 HPV 感染是复发的显著正预测因子。
