Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China; Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China; Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China.
Photodiagnosis Photodyn Ther. 2021 Mar;33:102172. doi: 10.1016/j.pdpdt.2020.102172. Epub 2021 Jan 2.
High-risk HPV infection is the main cause of cervical cancer and pre-cancerous lesions. The current principle of clinical management of cervical low-grade squamous intraepithelial lesion is observation for 2 years. Progression to high-grade squamous intraepithelial lesion warrants intervention. Primary treatment option is surgical excision which may have a negative impact on fertility. Topical photodynamic therapy is a non-invasive and targeted therapy. We investigated the clinical efficacy of this therapy for cervical low-grade squamous intraepithelial lesion with high-risk HPV infection.
A retrospective study consisting of 258 female patients aged 21-69 years with a histologically confirmed cervical low-grade squamous intraepithelial lesion with high-risk HPV infection was carried out. Subjects were treated with three sessions of 20 % 5-aminolevulinic acid photodynamic therapy at intervals of 7-14 days. Three months after treatment, the effect was evaluated through HPV typing, Thinprep cytology and colposcopy directed biopsy. Six months after treatment, the photodynamic therapy effect was evaluated by HPV genotyping and Thinprep cytology first, the pathological examination would be performed at the 6-month follow-up point if the cytological results indicated the risk of high-grade squamous intraepithelial lesions.
Three months after treatment, among 258 low-grade squamous intraepithelial lesion with high-risk HPV infection patients, total baseline HPV remission rates was 64.34 % (166/258). The remission rate of HPV16/18 group was not statistically significant compared to the HPV non-16/18 group (73.13 % vs 61.26 %, p = 0.081).The remission rates of the <50 age group was significantly higher than the >50 age group (67.28 %vs46.34 %, p = 0.001). The total lesion regression rate wa treatment, among 258 low-grade squamous intraepithelial lesion with high-risk HPV infection patients, total baseline HPV remission rates was 64.34 % (166/258). The remission rate of HPV16/18 group was not statistically significant compared to the HPV non-16/18 group (73.13 % vs 61.26 %, p = 0.081).The remission rates of the <50 age group was significantly higher than the >50 age group (67.28 %vs46.34 %, p = 0.001). The total lesion regression rate was 84.88 % (219/258). 12.8 % (33/258) of patients did not progress. Only 2.33 % (6/258) patients progressed to high-grade squamous intraepithelial lesion and accepted loop electrosurgical excision procedure. The patients >50 age group had significant higher progression rate than the patients ＜50 age group (p＜0.05). Six months after treatment, except for 6 patients who progressed to high-grade squamous intraepithelial lesion and underwent surgical treatment, the total baseline HPV remission rates was up to 82.54 % (208/252).
5-aminolevulinic acid photodynamic therapy was highly effective and did not appear to create cervical damage.. It might be an ideal treatment for cervical low-grade squamous intraepithelial lesion with high-risk HPV infection, but this requires additional clinical trials.
高危型 HPV 感染是宫颈癌及癌前病变的主要病因。目前，宫颈低级别鳞状上皮内病变的临床处理原则是观察 2 年。进展为高级别鳞状上皮内病变需要干预。主要的治疗选择是手术切除，这可能对生育能力产生负面影响。局部光动力疗法是一种非侵入性和靶向性治疗方法。我们研究了这种治疗方法对高危型 HPV 感染的宫颈低级别鳞状上皮内病变的临床疗效。
对 258 例年龄 21-69 岁、组织学证实为高危型 HPV 感染的宫颈低级别鳞状上皮内病变患者进行回顾性研究。患者接受三次 20% 5-氨基酮戊酸光动力治疗，间隔 7-14 天。治疗 3 个月后，通过 HPV 分型、液基细胞学和阴道镜指导活检评估疗效。治疗 6 个月后，首先通过 HPV 基因分型和液基细胞学评估光动力治疗效果，如果细胞学结果提示存在高级别鳞状上皮内病变的风险，则在 6 个月随访时进行病理检查。
治疗 3 个月后，258 例高危型 HPV 感染的宫颈低级别鳞状上皮内病变患者中，总基线 HPV 缓解率为 64.34%（166/258）。HPV16/18 组与 HPV 非 16/18 组的缓解率无统计学差异（73.13%比 61.26%，p=0.081）。＜50 岁年龄组的缓解率明显高于＞50 岁年龄组（67.28%比 46.34%，p=0.001）。总病变消退率为 84.88%（219/258）。12.8%（33/258）的患者没有进展。只有 2.33%（6/258）的患者进展为高级别鳞状上皮内病变并接受了环形电切术。＞50 岁年龄组的进展率明显高于＜50 岁年龄组（p＜0.05）。治疗 6 个月后，除 6 例进展为高级别鳞状上皮内病变并接受手术治疗的患者外，总基线 HPV 缓解率高达 82.54%（208/252）。
5-氨基酮戊酸光动力疗法疗效显著，且似乎不会造成宫颈损伤。它可能是高危型 HPV 感染的宫颈低级别鳞状上皮内病变的理想治疗方法，但这需要进一步的临床试验。
