Bogani Giorgio, Martinelli Fabio, Ditto Antonino, Signorelli Mauro, Taverna Francesca, Lombardo Claudia, Chiappa Valentina, Leone Roberti Maggiore Umberto, Recalcati Dario, Scaffa Cono, Perotto Stefania, Sabatucci Ilaria, Indini Alice, Lorusso Domenica, Raspagliesi Francesco
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:37-41. doi: 10.1016/j.ejogrb.2017.01.057. Epub 2017 Feb 1.
To assess whether pre-treatment HPV types are associated with recurrence of high-grade vulvar intraepithelial neoplasia (VIN2+).
Data of consecutive patients with pretreatment HPV DNA test undergoing treatment for VIN2+ were retrospectively collected. Risk factors promoting the risk of VIN2+ persistence and recurrence were analyzed using Kaplan-Meier and Cox hazard proportional models.
64 patients had pretreatment vulvar-vaginal HPV DNA test. Two were excluded due to the presence of synchronous vulvar cancer, thus leaving 62 patients for the final analysis. HPV16, HPV18, HPV31 and HPV33 were the most common HPV genotype detected, occurring in 15 (24.2%), 4 (6.5%), 8 (12.9%) and 5 (8.0%) patients, respectively. HPV was not detected in 19 (30.6%) patients. During a mean (SD) follow up of 56.7 (±26.7) months, 10 (16.1%) patients had VIN2+ persistence/recurrence. Mean (SD) lesion-free interval was 51.7 (±31.4) months. Via multivariate analysis, pretreatment infection from HPV31 (HR:46.7(95%CI:4.21,518.4); p=0.02) and HPV33 (HR:77.0(95%CI:6.73,881.9); p<0.001) correlated with an increased risk of VIN2+ persistence/recurrence. Additionally, we observed that patients undergoing surgical excision followed by LASER ablation experienced a trend towards lower recurrence rate than patients undergoing other surgical or medical treatments (HR:0.20(95%CI:0.03,1.09); p=0.05). Two (3.2%) patients developed progression to vulvar cancer.
Owing to the inherent biases of the retrospective study design and the small sample size, our data have to be corroborated by larger and prospective studies. HPV31 and HPV33 have a potential role in predicting VIN2+ persistence/recurrence. These findings will be paramount, owing to the implementation of new immunization programs.
评估治疗前的人乳头瘤病毒（HPV）类型是否与高级别外阴上皮内瘤变（VIN2+）的复发相关。
回顾性收集连续接受VIN2+治疗且治疗前进行HPV DNA检测的患者数据。使用Kaplan-Meier和Cox风险比例模型分析促进VIN2+持续存在和复发风险的危险因素。
64例患者进行了治疗前外阴-阴道HPV DNA检测。2例因同时存在外阴癌被排除，最终纳入分析的患者为62例。HPV16、HPV18、HPV31和HPV33是检测到的最常见HPV基因型，分别出现在15例（24.2%）、4例（6.5%）、8例（12.9%）和5例（8.0%）患者中。19例（30.6%）患者未检测到HPV。在平均（标准差）56.7（±26.7）个月的随访期间，10例（16.1%）患者出现VIN2+持续存在/复发。平均（标准差）无病变间隔时间为51.7（±31.4）个月。通过多变量分析，治疗前HPV31感染（风险比：46.7（95%置信区间：4.21,518.4）；p=0.02）和HPV33感染（风险比：77.0（95%置信区间：6.73,881.9）；p<0.001）与VIN2+持续存在/复发风险增加相关。此外，我们观察到，与接受其他手术或药物治疗的患者相比，接受手术切除后再行激光消融的患者复发率有降低趋势（风险比：0.20（95%置信区间：0.03,1.09）；p=0.05）。2例（3.2%）患者进展为外阴癌。
由于回顾性研究设计的固有偏差和样本量较小，我们的数据必须通过更大规模的前瞻性研究加以证实。HPV31和HPV33在预测VIN2+持续存在/复发方面具有潜在作用。鉴于新免疫计划的实施，这些发现至关重要。
