School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.
Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
BJOG. 2018 Jan;125(1):74-79. doi: 10.1111/1471-0528.14808. Epub 2017 Aug 2.
To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.
Retrospective cohort study.
Statewide population in Western Australia.
Women diagnosed with AIS between 2001 and 2012.
We conducted a retrospective, population-based cohort study.
De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.
636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.
In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.
Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.
比较单纯原位腺癌（AIS）和 AIS 伴 CIN2/3 混合病变患者的结局，包括 AIS 持续存在、复发和进展为腺癌的发生率。
回顾性队列研究。
西澳大利亚州。
2001 年至 2012 年间诊断为 AIS 的女性。
我们进行了一项回顾性的基于人群的队列研究。
利用去识别的关联数据来确定患者在接受切除术时的年龄、切缘状态、病变类型、病变大小与持续存在 AIS（定义为治疗后 12 个月内存在 AIS）、复发 AIS（治疗后≥12 个月）和腺癌之间的关联。
636 名患者符合分析条件。平均年龄为 32.3 岁，中位随访时间为 2.5 年。在研究队列中，266 名患者（41.8%）为单纯 AIS，370 名患者（58.2%）为 AIS 伴 CIN2/3 混合病变。总体而言，47 名患者（7.4%）出现 AIS 持续存在/复发，12 名患者（1.9%）发生腺癌。与持续存在/复发相关的因素有单纯 AIS（风险比（HR）2.3；95%CI 1.28-3.94；P=0.005）、年龄＞30 岁（HR 2.1；95%CI 1.16-3.81；P=0.015）、宫颈内口切缘阳性（HR 5.8；95%CI 3.05-10.92；P＜0.001）和 AIS 病变＞8mm（HR 2.5；95%CI 1.00-6.20；P=0.049）。宫颈外口切缘存在 AIS 组织学阳性与持续存在/复发无关。
在本研究中，与 AIS 伴 CIN2/3 混合病变相比，单纯 AIS 与更大的持续存在/复发风险相关。AIS 病变＞8mm 和宫颈内口切缘阳性是疾病持续存在或复发的显著预测因素。
单纯宫颈原位腺癌（AIS）的复发风险可能高于 AIS 伴 CIN2/3 混合病变。
