Tranoulis A, Laios A, Mitsopoulos V, Lutchman-Singh K, Thomakos N
Department of Gynaecological Oncology, Singleton Hospital NHS Foundation Trust, University of Swansea, UK.
Department of Gynaecological Oncology, St Jamess' University Hospital, Leeds, UK.
Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:129-136. doi: 10.1016/j.ejogrb.2017.09.020. Epub 2017 Sep 27.
Vaginal intraepithelial neoplasia (VaIN) is an uncommon disease associated with HPV and is considered to be a precursor of vaginal carcinoma. To date, treatment recommendations vary with no universally accepted standard of care as best treatment modality. Nevertheless, 5% imiquimod appears to be a promising, alternative, non-invasive treatment option. To ascertain the efficacy of 5% imiquimod for the treatment of this rare condition, we conducted a systematic review and meta-analysis of the proportion of women who received 5% imiquimod with their complete response, HPV clearance and recurrence rates. A literature search was carried out throughout the PubMed, EMBASE, ClinicalTrials.gov and Cochrane Databases for relevant studies. We computed the summary proportions for complete response, HPV clearance and non-recurrence following administration of 5% imiquimod by random effects meta-analysis. Six articles reporting on 94 patients were included. The summary proportions of women with complete response and HPV clearance were 76.5% (95% CI 59.4-98.5) and 52.5% (95% CI 29.5-93.6) respectively. The summary proportion of women with non-recurrence appeared high (94.3% (95% CI 67.1-132)), yet not significant. Use of 5% imiquimod for the treatment of VaIN is associated with relatively high response rate, satisfactory HPV clearance, whilst the risk for VaIN recurrence appears low.
阴道上皮内瘤变（VaIN）是一种与人类乳头瘤病毒（HPV）相关的罕见疾病，被认为是阴道癌的癌前病变。迄今为止，治疗建议各不相同，尚无普遍接受的最佳治疗方式的标准护理方案。然而，5%咪喹莫特似乎是一种有前景的、替代性的非侵入性治疗选择。为确定5%咪喹莫特治疗这种罕见病症的疗效，我们对接受5%咪喹莫特治疗且有完全缓解、HPV清除率和复发率的女性比例进行了系统评价和荟萃分析。在PubMed、EMBASE、ClinicalTrials.gov和Cochrane数据库中进行了文献检索，以查找相关研究。我们通过随机效应荟萃分析计算了给予5%咪喹莫特后完全缓解、HPV清除和无复发的汇总比例。纳入了6篇报道94例患者的文章。完全缓解和HPV清除的女性汇总比例分别为76.5%（95%可信区间59.4 - 98.5）和52.5%（95%可信区间29.5 - 93.6）。无复发女性的汇总比例似乎较高（94.3%（95%可信区间67.1 - 132）），但无统计学意义。使用5%咪喹莫特治疗VaIN的缓解率相对较高，HPV清除情况良好，而VaIN复发风险似乎较低。
