Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Department of Pathology and Laboratory Medicine, IRCCS National Cancer Institute, Milan, Italy.
J Gynecol Oncol. 2019 Mar;30(2):e20. doi: 10.3802/jgo.2019.30.e20. Epub 2018 Nov 8.
We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia.
Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models.
Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range,5-42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21-0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15-13.0; p=0.028).
Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes.
我们研究了患有复发性高级别阴道上皮内瘤变的女性的结局。
检索了经初次治疗后诊断为复发性高级别阴道上皮内瘤变的连续女性患者的数据。使用 Kaplan-Meier 和 Cox 模型评估随时间发展出现新复发的风险。
可分析 117 名女性的数据。初次诊断时，41 名（35%）、4 名（3.4%）和 72 名（61.6%）患者分别接受了激光、单纯手术和药物治疗。二级治疗包括：95 例（81.2%）和 22 例（18.8%）患者分别接受了激光消融和药物治疗。在平均（标准差）随访 72.3（±39.5）个月后，整个 117 名患者队列中有 37 名（31.6%）出现第二次复发。中位复发时间为 20（范围，5-42）个月。与接受激光治疗的患者相比，接受药物治疗的复发性高级别阴道上皮内瘤变患者发生第二次复发的风险更高（p=0.013，对数秩检验）。在我们为复发性疾病所采用的治疗方法校正结果后，我们观察到初次激光治疗的执行与新发复发的风险降低独立相关（风险比[HR]=0.46；95%置信区间[CI]=0.21-0.99；p=0.050）。与新发复发独立相关的另一个变量是 HPV16 或 18 的持续感染（HR=3.87；95% CI=1.15-13.0；p=0.028）。
患有复发性高级别阴道上皮内瘤变的患者有发生新复发的高风险。我们的数据强调，初次治疗的选择可能会对进一步的结局产生影响。
