Bogani Giorgio, Martinelli Fabio, Ditto Antonino, Taverna Francesca, Lombardo Claudia, Signorelli Mauro, Chiappa Valentina, Leone Roberti Maggiore Umberto, Fontanella Caterina, Sabatucci Ilaria, Borghi Chiara, Recalcati Dario, Indini Alice, Lorusso Domenica, Raspagliesi Francesco
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Department of Immunohematology and Transfusion Medicine Service, IRCCS National Cancer Institute, Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:157-165. doi: 10.1016/j.ejogrb.2016.12.020. Epub 2016 Dec 23.
High-grade vaginal intraepithelial neoplasia (vaginal HSIL) represents an uncommon entity. Here, we sought to identify predictors for recurrence and risk factor for developing genital cancers after primary treatment for vaginal HSIL.
Data of consecutive 5104 women who had human papillomavirus (HPV) DNA test were searched for identify women with histological confirmed vaginal HSIL. Disease-free interval and the risk of developing HPV-related gynecological cancers were assessed using Kaplan-Meier and Cox proportional hazard models.
Overall, 77 patients were included. After a mean (SD) follow-up of 69.3 (33.0) months, 11 (14%) and 4 (5%) patients experienced vaginal HSIL recurrence and the occurrence of HPV-related gynecological cancers, respectively. Via multivariate analysis factors predicting for vaginal HSIL recurrence were infection from HPV31 at diagnosis (HR: 5.0 (95%CI:1.17, 21.3); p=0.03) and persistence of HPV infection after treatment (HR: 7.0 (95%CI:1.54, 31.6); p=0.01). Additionally, patients who had LASER ablation experienced a trend toward a lower risk of recurrence in comparison to medical treatment (HR: 0.20 (95%CI:0.03, 1.09); p=0.06). Considering the occurrence of HPV-related gynecological cancers, we observed that no factors independently correlated with this risk; while, a trend towards higher risk was observed for women with HIV infection (HR:16.4 (95%CI:0.90, 300.1); p=0.06) and persistence of HPV infection (HR: 13.3 (95%CI:0.76, 230.2); p=0.07).
Patients affected by vaginal HSIL experienced a relatively high risk of recurrence. Persistence of HPV after treatment and pretreatment HPV-31 infection predicts for high-grade vaginal intraepithelial neoplasia recurrence. Further investigations are warranted in order to corroborate our data.
高级别阴道上皮内瘤变（阴道HSIL）是一种不常见的病症。在此，我们试图确定阴道HSIL初次治疗后复发的预测因素以及发生生殖器癌症的风险因素。
检索连续5104例进行人乳头瘤病毒（HPV）DNA检测的女性数据，以确定经组织学确诊为阴道HSIL的女性。采用Kaplan-Meier法和Cox比例风险模型评估无病间期及发生HPV相关妇科癌症的风险。
总共纳入77例患者。平均（标准差）随访69.3（33.0）个月后，分别有11例（14%）和4例（5%）患者出现阴道HSIL复发及HPV相关妇科癌症。多因素分析显示，诊断时HPV31感染（HR：5.0（95%CI：1.17，21.3）；p=0.03）和治疗后HPV感染持续存在（HR：7.0（95%CI：1.54，31.6）；p=0.01）是阴道HSIL复发的预测因素。此外，与药物治疗相比，接受激光消融的患者复发风险有降低趋势（HR：0.20（95%CI：0.03，1.09）；p=0.06）。关于HPV相关妇科癌症的发生，我们观察到没有因素与该风险独立相关；然而，HIV感染女性（HR：16.4（95%CI：0.90，300.1）；p=0.06）和HPV感染持续存在（HR：13.3（95%CI：0.76，230.2）；p=0.07）有风险升高趋势。
阴道HSIL患者复发风险相对较高。治疗后HPV持续存在和治疗前HPV-31感染可预测高级别阴道上皮内瘤变复发。有必要进一步研究以证实我们的数据。
