Mungo Chemtai, Cohen Craig R, Maloba May, Bukusi Elizabeth A, Huchko Megan J
Doris Duke Clinical Research Fellow, University of California San Francisco, San Francisco, USA.
Int J Gynaecol Obstet. 2013 Dec;123(3):231-5. doi: 10.1016/j.ijgo.2013.07.010. Epub 2013 Sep 10.
To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya.
We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic.
Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34years (range, 22-50years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36 (66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11 (20.4%) had unknown or no treatment. At 6, 12, and 24months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively.
Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment; however, recurrence was high, indicating the need for continued surveillance.
确定侵袭性宫颈癌（ICC）的患病率，并评估肯尼亚基苏木感染艾滋病毒女性中ICC的治疗可及性和治疗结果。
我们进行了一项回顾性病历审查，以确定2007年10月至2012年6月期间被诊断为ICC的女性，并研究转诊方案改变的影响。2009年6月之前，所有ICC女性均被转诊至一家地区医院。在此日期之后，IA1期疾病的女性在诊所接受环形电切术（LEEP）治疗。
在4308名接受筛查的女性中，58名（1.3%）被诊断为ICC。诊断时的平均年龄为34岁（范围22 - 50岁）。54名（93.1%）女性患有IA1期疾病，其中36名（66.7%）接受了LEEP治疗，7名（12.9%）接受了全腹子宫切除术，11名（20.4%）治疗情况不明或未接受治疗。在LEEP术后6、12和24个月，分别有8.0%（2/25）、25.0%（6/24）和41.2%（7/17）的女性出现宫颈上皮内瘤变2级或更严重病变的复发。
通过筛查诊断为ICC的大多数艾滋病毒阳性女性患有早期疾病。诊所引入LEEP增加了治疗可及性；然而，复发率很高，表明需要持续监测。
