Cao Dan, Wu Dan, Xu Ying
The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Curr Probl Cancer. 2021 Jun;45(3):100687. doi: 10.1016/j.currproblcancer.2020.100687. Epub 2020 Dec 4.
To investigate the incidence of vaginal intraepithelial neoplasia (VaIN) after total hysterectomy and, subsequently, optimize the follow-up strategy of patients after hysterectomy.
This retrospective study was conducted on 8581 patients with benign gynecology disease who underwent total hysterectomy in our institution between January 2006 to December 2017, including 834 patients with cervical intraepithelial neoplasia (CIN) and 7747 patients without cervical lesions before hysterectomy. All patients underwent postoperative high-risk human papilloma virus (Hr-HPV) screening and liquid-based cytology test (LCT) as confirmatory tests. Colposcopies were performed if the results of the confirmatory tests were abnormal, and biopsies were performed depending on colposcopy images. The mean follow-up time was 33.8 ± 12.1 months. The relationship among VaIN, CIN, and confirmatory test results was investigated.
VaIN was found in 81 patients after hysterectomy (incidence rate, 0.9%). The incidence rates of VaIN in patients with and without CIN history were significantly different (7.3%, 61/834, vs 0.3%, 20/7747; P < 0.05). Compared with patients without CIN history, those with CIN history were more likely to have abnormal LCT results in the postoperative follow-up, especially low-grade squamous intraepithelial lesions or worse (P < 0.001). Patients with high-grade squamous intraepithelial lesions in the LCT have a high VaIN incidence (patients with CIN history, 57.1%; patients without CIN history, 15.1%), and the 2 patients with squamous cell carcinoma or adenocarcinoma (SCC/AC) in the LCT had CIN and VaIN or worse after hysterectomy. The Hr-HPV infection rates after the hysterectomy of patients with and without CIN history were 18.8% (157/834) and 5.4% (419/7747), respectively. The incidences morbidities of VaIN in patients with persistent Hr-HPV infection and in those with and without CIN history were 35.7% and 12.0%, respectively, and were significantly higher than those in patients with negative Hr-HPV (patients with CIN history, 0.7%; patients without CIN history, 0.1%; P = 0.002). The incidence of VaIN in patients with CIN history with HPV-16 infection after hysterectomy was as high as 50%, but in patients without CIN history, the incidences of different Hr-HPV subtypes were not significantly different (P = 0.953).
Patients with CIN history were more prone to VaIN and SCC after hysterectomy than were patients without CIN history. Patients should be screened thoroughly for cervical and vaginal lesions before hysterectomy. After hysterectomy, patients with CIN history should undergo lifetime annual LCT and HPV screening.
探讨全子宫切除术后阴道上皮内瘤变（VaIN）的发生率，并据此优化子宫切除术后患者的随访策略。
本回顾性研究纳入了2006年1月至2017年12月期间在我院接受全子宫切除术的8581例妇科良性疾病患者，其中包括834例术前有宫颈上皮内瘤变（CIN）的患者和7747例术前无宫颈病变的患者。所有患者术后均接受高危型人乳头瘤病毒（Hr-HPV）筛查及液基细胞学检查（LCT）作为确诊检查。确诊检查结果异常者行阴道镜检查，并根据阴道镜图像进行活检。平均随访时间为33.8±12.1个月。研究VaIN、CIN与确诊检查结果之间的关系。
全子宫切除术后81例患者被诊断为VaIN（发生率为0.9%）。有CIN病史和无CIN病史患者的VaIN发生率有显著差异（7.3%，61/834， vs 0.3%，20/7747；P<0.05）。与无CIN病史的患者相比，有CIN病史的患者术后随访中LCT结果更易异常，尤其是低度鳞状上皮内病变及更严重病变（P<0.001）。LCT结果为高度鳞状上皮内病变的患者VaIN发生率较高（有CIN病史的患者为57.1%；无CIN病史的患者为15.1%），LCT结果为鳞状细胞癌或腺癌（SCC/AC）的2例患者在子宫切除术后发生了CIN和VaIN或更严重病变。有CIN病史和无CIN病史患者子宫切除术后的Hr-HPV感染率分别为18.8%（157/834）和5.4%（419/7747）。持续Hr-HPV感染的患者及有和无CIN病史患者的VaIN发病率分别为35.7%和12.0%，均显著高于Hr-HPV阴性患者（有CIN病史的患者为0.7%；无CIN病史的患者为0.1%；P = 0.002）。有CIN病史且术后感染HPV-16的患者VaIN发生率高达50%，但无CIN病史的患者中，不同Hr-HPV亚型的发生率无显著差异（P = 0.953）。
有CIN病史的患者子宫切除术后比无CIN病史的患者更易发生VaIN和SCC。子宫切除术前应对患者进行宫颈和阴道病变的全面筛查。子宫切除术后，有CIN病史的患者应每年进行一次LCT和HPV筛查，终身随访。
