三氯乙酸治疗宫颈上皮内瘤变的短期疗效。

Short-Term Efficacy of Trichloroacetic Acid in the Treatment of Cervical Intraepithelial Neoplasia.

机构信息

Department of Obstetrics and Gynecology, Clinical Division for General Gynecology and Gynecological Oncology, and the Center for Medical Statistics, Information and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, and the Karl Landsteiner University of Health Sciences, Krems, Austria; and the Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom.

出版信息

Obstet Gynecol. 2016 Feb;127(2):353-9. doi: 10.1097/AOG.0000000000001244.

DOI:10.1097/AOG.0000000000001244

PMID:26942365

Abstract

OBJECTIVE

To establish the short-term efficacy and tolerability of a single topical 85% trichloroacetic acid treatment for cervical intraepithelial neoplasia (CIN) 1-3.

METHODS

A retrospective case series including all patients with CIN treated with trichloroacetic acid as first-line therapy was performed. Treatment response was evaluated by colposcopy, cervical biopsy, cytology, and type-specific human papillomavirus (HPV) testing 8 weeks after a single trichloroacetic acid treatment. Regression was defined as improvement from high-grade to low-grade CIN and remission was defined as improvement from any grade of CIN to no CIN. For quantification of treatment-related pain, 107 (44.1%) patients rated their subjective perception on a visual analog scale.

RESULTS

A total of 241 women were included in the study with 179 high-grade (CIN 2-3) and 62 low-grade (CIN 1) squamous intraepithelial lesions. For high-grade squamous intraepithelial lesions, the histologic regression rate was 87.7% (95% confidence interval [CI] 82.0-92.1) and the remission rate was 80.3% (95% CI 73.3-85.5). For low-grade squamous intraepithelial lesions, the remission rate was 82.3% (95% CI 70.5-90.8). Human papillomavirus types 16 and 18 were found in 53.7% and 7.3% of all women tested, respectively. Clearance rates of HPV type 16 and HPV type 18 were 73.5% (95% CI 62.5-81.3) and 75.0% (95% CI 46.2-95.0), respectively. Median pain score was 3.0 out of 10.0 (25th and 75th percentiles 2.3 and 4.3, respectively). There were no major side effects observed during treatment or follow-up.

CONCLUSION

A high regression and remission rate and a high HPV clearance rate were observed 8 weeks after topical 85% trichloroacetic acid treatment for patients with CIN.

摘要

目的

评估 85%三氯乙酸单次局部治疗宫颈上皮内瘤变（CIN）1-3 的短期疗效和耐受性。

方法

本研究回顾性纳入了所有接受三氯乙酸作为一线治疗的 CIN 患者，通过阴道镜、宫颈活检、细胞学和 HPV 检测评估治疗反应，这些检查均在单次三氯乙酸治疗 8 周后进行。从高级别 CIN 转为低级别 CIN 定义为疾病消退，从任何级别 CIN 转为无 CIN 定义为完全缓解。为了量化与治疗相关的疼痛程度，107 例（44.1%）患者使用视觉模拟评分法对其主观感受进行评分。

结果

共纳入 241 例患者，其中 179 例为高级别（CIN 2-3）病变，62 例为低级别（CIN 1）病变。对于高级别鳞状上皮内病变，组织学缓解率为 87.7%（95%可信区间[CI]为 82.0-92.1），完全缓解率为 80.3%（95%CI 为 73.3-85.5）。对于低级别鳞状上皮内病变，完全缓解率为 82.3%（95%CI 为 70.5-90.8）。所有患者中 HPV 16 型和 HPV 18 型的检出率分别为 53.7%和 7.3%。HPV 16 型和 HPV 18 型的清除率分别为 73.5%（95%CI 为 62.5-81.3）和 75.0%（95%CI 为 46.2-95.0）。中位疼痛评分为 10.0 分中的 3.0 分（25%和 75%分位数分别为 2.3 和 4.3）。治疗期间和随访期间均未观察到严重不良反应。