Clinical Epidemiology and Clinical Governance Support Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy.
Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy.
J Med Screen. 2023 Dec;30(4):191-200. doi: 10.1177/09691413231175630. Epub 2023 May 25.
(a) To estimate the risk of recurrent cervical intraepithelial neoplasia, grade 2/3 or worse (CIN2+/CIN3+), lesions within 5 years of follow-up in human papillomavirus-negative/human papillomavirus-positive cohorts; (b) to assess whether certain risk factors can predict the recurrence of CIN2+/CIN3+ lesions; and (c) to provide recommendations for follow-up after treatment of cervical intraepithelial neoplasia, grade 2/3 to prevent cervical cancer
Organized cervical cancer screening programme in Central Italy.
We included 1063 consecutive first excisional treatments performed between 2006 and 2014 for screening-detected cervical intraepithelial neoplasia, grade 2/3 lesions among women aged 25-65. The study population was divided into two groups according to the human papillomavirus test results performed 6 months after treatment: Human papillomavirus-negative and human papillomavirus-positive cohorts. The 5-year risk of developing cervical intraepithelial neoplasia, grade 2/3 or worse (CIN2+/CIN3+) was estimated using the Kaplan-Meier method and the Cox regression model.
Among 829 human papillomavirus-negative and 234 human papillomavirus-positive women, six (0.72%; three cervical intraepithelial neoplasia, grade 2, three cervical intraepithelial neoplasia, grade 3) and 45 (19.2%; 15 cervical intraepithelial neoplasia, grade 2, 30 cervical intraepithelial neoplasia, grade 3), respectively, developed CIN2+ recurrence within 5 years of follow-up. The cumulative risks for CIN2+ and CIN3+ were 0.9% (95% confidence interval: 0.4%-2.0%) and 0.5% (95% confidence interval: 0.1%-1.4%), respectively, for the human papillomavirus-negative cohort, and 24.8% (95% confidence interval: 18.5%-32.7%) and 16.9% (95% confidence interval: 11.4%-24.5%), respectively, for the human papillomavirus-positive cohort. Risk factors associated with increased risk of recurrence were both margins positive for the human papillomavirus-negative cohort, and positive margins, cervical intraepithelial neoplasia, grade 3 lesions, high-grade cytology and high viral load for the human papillomavirus-positive cohort.
Human papillomavirus testing can identify women at increased risk of recurrence and this supports a recommendation for its use in the post-treatment follow-up of cervical intraepithelial neoplasia, grade 2/3 lesions.
(a) 评估 HPV 阴性/HPV 阳性队列中，随访 5 年内 CIN2+/CIN3+病变的复发风险；(b) 评估某些危险因素是否能预测 CIN2+/CIN3+病变的复发；(c) 为 HPV 阴性和 HPV 阳性的 CIN2/3 患者的治疗后随访提供建议，以预防宫颈癌。
意大利中部有组织的宫颈癌筛查项目。
我们纳入了 2006 年至 2014 年间，在筛查中发现的 1063 例连续的宫颈上皮内瘤变 2/3 级病变的初次锥切治疗患者，这些患者年龄在 25-65 岁之间。根据治疗后 6 个月的 HPV 检测结果，将研究人群分为两组：HPV 阴性组和 HPV 阳性组。采用 Kaplan-Meier 法和 Cox 回归模型估计 5 年内发生 CIN2/3 级及以上病变（CIN2+/CIN3+）的风险。
在 829 例 HPV 阴性和 234 例 HPV 阳性的女性中，分别有 6 例（0.72%；3 例 CIN2 级，3 例 CIN3 级）和 45 例（19.2%；15 例 CIN2 级，30 例 CIN3 级）在随访 5 年内发展为 CIN2+病变。HPV 阴性组的 CIN2+和 CIN3+累积风险分别为 0.9%（95%置信区间：0.4%-2.0%）和 0.5%（95%置信区间：0.1%-1.4%），HPV 阳性组的分别为 24.8%（95%置信区间：18.5%-32.7%）和 16.9%（95%置信区间：11.4%-24.5%）。与 HPV 阴性组相比，HPV 阳性组的复发风险增加的危险因素是切缘阳性，与 HPV 阳性组相比，HPV 阳性组的复发风险增加的危险因素是 CIN3 级病变、高级别细胞学和高病毒载量。
HPV 检测可识别复发风险较高的女性，支持在治疗后对 CIN2/3 病变进行 HPV 检测随访。
