Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Central Hospital of Minhang District, Fudan University, Shanghai, China.
Photodiagnosis Photodyn Ther. 2023 Sep;43:103721. doi: 10.1016/j.pdpdt.2023.103721. Epub 2023 Jul 27.
To evaluate the effect of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with CO2 laser pretreatment (Laser+ALA-PDT) on patients with cervical high-grade squamous intraepithelial lesions (HSILs).
A total of 114 patients treated by ALA-PDT or Laser+ALA-PDT at 3 centers were retrospectively reviewed. The effective rate, cure rate of lesions as well as high-risk human papillomavirus (HR-HPV) regression rate and persistent infection rate in the 2 groups were compared according to 3-6 month and 9-12 months follow-ups. The characteristics and risk factors for ineffective cases were evaluated by regression analysis.
At the 3-6month follow-up, the effective rate was significantly higher in the Laser+ALA-PDT group than in the ALA-PDT group (96.6% vs. 81.3%, p = 0.048). A total of 79.3% of the laser+ALA-PDT patients achieved cure rate compared with 61.3% of the ALA-PDT patients (p = 0.082). In the Laser+ALA-PDT group, the HR-HPV-negative rate was significantly higher (72.4% vs. 50.7%, p = 0.045), while the persistence rate was significantly lower (20.7% vs. 42.7%, p = 0.037). At the 9-12month follow-up, the cure rate was 83% in the ALA-PDT group, 17% lower than that in the Laser+ALA-PDT group (p = 0.055). A total of 20.8% of patients in the ALA-PDT group and 5.3% in the Laser+ALA-PDT group showed persistent HR-HPV infection (p = 0.120). Pretreatment HR-HPV type, multiple infections and treatment modality were relevant factors for PDT outcome.
For patients with cervical HSIL, laser+ALA-PDT shows better efficiency and HPV regression compared with ALA-PDT. HPV16/18 and multi-infection may be risk factors for ineffective treatment with ALA-PDT.
评估 5-氨基酮戊酸光动力疗法（ALA-PDT）联合 CO2 激光预处理（Laser+ALA-PDT）治疗宫颈高级别鳞状上皮内病变（HSIL）患者的疗效。
回顾性分析 3 家中心的 114 例接受 ALA-PDT 或 Laser+ALA-PDT 治疗的患者。根据 3-6 个月和 9-12 个月的随访，比较两组的有效率、病变治愈率以及高危型人乳头瘤病毒（HR-HPV）的消退率和持续感染率。通过回归分析评估无效病例的特征和危险因素。
在 3-6 个月的随访中，Laser+ALA-PDT 组的有效率显著高于 ALA-PDT 组（96.6% vs. 81.3%，p=0.048）。Laser+ALA-PDT 组的完全治愈率为 79.3%，高于 ALA-PDT 组的 61.3%（p=0.082）。在 Laser+ALA-PDT 组，HR-HPV 阴性率显著更高（72.4% vs. 50.7%，p=0.045），而持续感染率显著更低（20.7% vs. 42.7%，p=0.037）。在 9-12 个月的随访中，ALA-PDT 组的治愈率为 83%，比 Laser+ALA-PDT 组低 17%（p=0.055）。ALA-PDT 组有 20.8%的患者和 Laser+ALA-PDT 组有 5.3%的患者出现持续的 HR-HPV 感染（p=0.120）。预处理 HR-HPV 型别、多重感染和治疗方式是 PDT 疗效的相关因素。
对于宫颈 HSIL 患者，Laser+ALA-PDT 与 ALA-PDT 相比具有更好的疗效和 HPV 消退率。HPV16/18 感染和多重感染可能是 ALA-PDT 治疗无效的危险因素。
