Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Gynecol Oncol. 2021 Sep;162(3):569-574. doi: 10.1016/j.ygyno.2021.06.019. Epub 2021 Jul 2.
The purpose of this study was to evaluate the role of HPV genotyping and previous cytology result to predict the evolution of CIN2 histological lesions managed conservatively.
A prospective observational study was conducted at Hospital del Mar in Barcelona from January 2012 to May 2017. Women with new diagnosis of CIN2 were invited to undergo conservative management for 24 months. Complete regression, partial regression, persistence and progression to CIN3 were defined as final outcomes. Univariate and multivariate analyses combining HPV genotyping and cytology were used to establish progression predictors of CIN2.
A total of 300 patients were included in the study, and 291 patients completed the 24-months follow-up. Of them, 214 patients (73.5%) showed regression; 43 (14.8%) persistence to CIN2, and 34 (11.7%) progression to CIN3. In multivariable analysis, HPV-16 infection (odds ratio [OR] 1.97, [95% confidence interval {CI} 1.13-3.43]) and previous HSIL cytology (OR 3.46, [95% CI 1.99-6.02]) significantly increased the risk of persistence or progression (CIN2+) of CIN2 lesions. In contrast, all HPV-negative lesions regressed (p < 0.001).
The regression rate of CIN2 lesions supports conservative management in selected patients regardless of their age. Patients with a CIN2 biopsy and negative HPV test had a high rate of regression and should be offered follow-up without excisional treatment. In contrast, patients with HPV-16 and HSIL cytology had an increased risk of CIN2+, their treatment should be individualized and excisional treatment should be considered. The age may not be considered a criterion to decide the best management. New markers may help in the future to select the best management of CIN2.
本研究旨在评估 HPV 基因分型和既往细胞学结果在预测经保守治疗的 CIN2 组织学病变进展中的作用。
本研究为巴塞罗那德尔玛医院于 2012 年 1 月至 2017 年 5 月进行的一项前瞻性观察性研究。对新诊断为 CIN2 的女性患者进行 24 个月的保守治疗。完全消退、部分消退、持续存在和进展为 CIN3 定义为最终结局。采用单变量和多变量分析结合 HPV 基因分型和细胞学检查，以确定 CIN2 进展的预测因子。
共纳入 300 例患者，291 例患者完成 24 个月随访。其中，214 例（73.5%）病变消退；43 例（14.8%）持续存在 CIN2，34 例（11.7%）进展为 CIN3。多变量分析显示，HPV-16 感染（比值比 [OR] 1.97，95%置信区间 [CI] 1.13-3.43）和既往 HSIL 细胞学（OR 3.46，95%CI 1.99-6.02）显著增加了 CIN2 病变持续存在或进展（CIN2+）的风险。相比之下，所有 HPV 阴性病变均消退（p<0.001）。
CIN2 病变的消退率支持在选择的患者中进行保守治疗，无论其年龄大小。CIN2 活检且 HPV 检测阴性的患者有较高的消退率，应在不进行切除治疗的情况下提供随访。相比之下，HPV-16 阳性和 HSIL 细胞学患者 CIN2+的风险增加，其治疗应个体化，并考虑进行切除治疗。年龄可能不是决定最佳治疗方法的标准。新的标志物可能有助于未来选择 CIN2 的最佳治疗方法。
