宫颈上皮内瘤变（CIN）子宫切除术后阴道上皮内瘤变的危险因素及治疗。

Risk Factor and Treatment of Vaginal Intraepithelial Neoplasia After Hysterectomy for Cervical Intraepithelial Neoplasia.

机构信息

Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea.

Department of Obstetrics and Gynecology, Ujeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea.

出版信息

J Low Genit Tract Dis. 2022 Apr 1;26(2):147-151. doi: 10.1097/LGT.0000000000000664.

DOI:10.1097/LGT.0000000000000664

PMID:35238809

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8936153/

Abstract

OBJECTIVES

The aim of the study were to identify the risk factors for recurrent vaginal intraepithelial neoplasia (VaIN)1+ and to evaluate the efficacy of laser vaporization in patients who underwent hysterectomy for the treatment of cervical intraepithelial neoplasia (CIN).

METHODS

Medical records of 374 women who underwent hysterectomy for the treatment of CIN were retrospectively reviewed. Recurrence was defined as VaIN1+ diagnosis by colposcopy-directed biopsy.

RESULTS

Among 374 patients, 36 (9.6%) had VaIN1+ during a median follow-up of 32 (0-193) months: 13 (3.5%) had VaIN1, 6 (1.6%) VaIN2, 15 (4.0%) VaIN3, and 2 (0.5%) invasive cancer. Multivariate analysis showed that age of greater than 50 years was the only independent risk factor for VaIN1+ recurrence (odds ratio, 3.359; 95% CI, 1.60-7.07; p = .001). Among the 34 patients with VaIN, 21 (61.8%) were treated with laser vaporization and 11 (32.3%) were observed without treatment. Time to second recurrence was longer in the VaIN treated by laser vaporization group than that in the observation group (mean time to subsequent recurrence, 128.7 [95% CI, 101.4-156.0] vs. 41.8 [15.7-67.9] months; p = .003). Moreover, laser vaporization (hazard ratio, 0.125; 95% CI, 0.03-0.59; p = .009) was the only independent good prognostic factor for the second VaIN1+ recurrence.

CONCLUSIONS

Patients older than 50 years who underwent hysterectomy for the treatment of CIN might be highly at risk of VaIN1+. Laser vaporization is the only independent prognostic factor that might prevent the second VaIN1+ recurrence.

摘要

目的

本研究旨在确定复发性阴道上皮内瘤变（VaIN）1+的危险因素，并评估激光汽化治疗宫颈上皮内瘤变（CIN）患者的疗效。

方法

回顾性分析 374 例行子宫切除术治疗 CIN 的患者的病历。复发定义为阴道镜活检诊断为 VaIN1+。

结果

在 374 例患者中，36 例（9.6%）在中位随访 32（0-193）个月时出现 VaIN1+：13 例（3.5%）为 VaIN1，6 例（1.6%）为 VaIN2，15 例（4.0%）为 VaIN3，2 例（0.5%）为浸润性癌。多因素分析显示，年龄大于 50 岁是 VaIN1+复发的唯一独立危险因素（优势比，3.359；95%置信区间，1.60-7.07；p=.001）。在 34 例 VaIN 患者中，21 例（61.8%）接受了激光汽化治疗，11 例（32.3%）未接受治疗。激光汽化治疗组的第二次复发时间长于观察组（平均复发时间，128.7[95%置信区间，101.4-156.0] vs. 41.8[15.7-67.9]个月；p=.003）。此外，激光汽化（风险比，0.125；95%置信区间，0.03-0.59；p=.009）是第二次 VaIN1+复发的唯一独立预后良好因素。