Division of Gynecologic Oncology, Brigham and Women's Hospital, and the Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston; Massachusetts; Department of Population & Data Sciences and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and the Parkland Health and Hospital System, Dallas, Texas; the Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois; the Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Obstet Gynecol. 2023 Nov 1;142(5):1125-1134. doi: 10.1097/AOG.0000000000005313. Epub 2023 Aug 21.
OBJECTIVE: To quantify the association between time to colposcopy and risk of subsequent cervical cancer. METHODS: A longitudinal analysis of patients aged 21-79 years with an abnormal cervical cancer test result from health care systems in Texas, Massachusetts, and Washington was performed. The outcome was a cervical cancer diagnosis 12 months or more after the abnormal result. The primary analysis compared receipt of colposcopy within 3 months (91 days or less) with receipt of colposcopy at 3-12 months (92-365 days) and no colposcopy within 12 months of the abnormal test result; post hoc analyses compared colposcopy within 12 months (365 days or less) with no colposcopy within 12 months. Associations were assessed with multivariable Cox proportional hazards regression controlling for age, risk status, result severity, and health care system. RESULTS: Of 17,541 patients, 53.3% of patients received colposcopy within 3 months, 22.2% received colposcopy in 3-12 months, and 24.6% had no colposcopy within 12 months. One hundred forty-seven patients were diagnosed with cervical cancer within 12 months and removed from subsequent analyses. Sixty-five patients (0.4%) were diagnosed with cervical cancer more than 1 year (366 days or more) after the abnormal Pap or human papillomavirus test result. The risk of cervical cancer detection more than 1 year after the abnormal test result was not different in patients who received colposcopy within 3-12 months (hazard ratio [HR] 1.07, 95% CI 0.54-2.12) and higher among patients with no colposcopy within 12 months (HR 2.34, 95% CI 1.33-4.14) compared with patients who had colposcopy within 3 months. Post hoc analyses showed that the risk of cervical cancer diagnosis was 2.29-fold higher among those without colposcopy within 12 months compared with those who received colposcopy within 12 months (95% CI 1.37-3.83); among patients with high-grade cytology results, the risk of cervical cancer detection among those without colposcopy within 12 months was 3.12-fold higher compared with those who received colposcopy within 12 months (95% CI 1.47-6.70). CONCLUSION: There was no difference in cervical cancer risk at more than 1 year between patients who received colposcopy within 3 months compared with those who received colposcopy within 3-12 months of an abnormal result. Patients who did not receive colposcopy within 12 months of an abnormal result had a higher risk of subsequent cervical cancer compared with those who received a colposcopy within 12 months.
目的：量化阴道镜检查时间与宫颈癌后续风险之间的关联。
方法：对来自德克萨斯州、马萨诸塞州和华盛顿卫生保健系统的年龄在 21-79 岁之间、宫颈癌检查结果异常的患者进行了纵向分析。结局是在异常结果后 12 个月或更长时间发生宫颈癌诊断。主要分析比较了在 3 个月内（91 天或更短）接受阴道镜检查与在 3-12 个月内（92-365 天）接受阴道镜检查和 12 个月内未接受阴道镜检查之间的差异；事后分析比较了 12 个月内（365 天或更短）接受阴道镜检查与 12 个月内未接受阴道镜检查之间的差异。使用多变量 Cox 比例风险回归评估关联，控制年龄、风险状况、结果严重程度和卫生保健系统。
结果：在 17541 名患者中，53.3%的患者在 3 个月内接受了阴道镜检查，22.2%的患者在 3-12 个月内接受了阴道镜检查，24.6%的患者在 12 个月内未接受阴道镜检查。147 名患者在 12 个月内被诊断为宫颈癌，并从后续分析中删除。65 名患者（0.4%）在异常巴氏试验或人乳头瘤病毒试验结果后 1 年（366 天或更长时间）被诊断为宫颈癌。在 3-12 个月内接受阴道镜检查的患者（风险比[HR]1.07，95%CI0.54-2.12）和 12 个月内未接受阴道镜检查的患者（HR2.34，95%CI1.33-4.14）中，异常试验结果后 1 年发现宫颈癌的风险并无差异，与在 3 个月内接受阴道镜检查的患者相比。事后分析表明，与 12 个月内接受阴道镜检查的患者相比，12 个月内未接受阴道镜检查的患者宫颈癌诊断风险高 2.29 倍（95%CI1.37-3.83）；在高级别细胞学结果患者中，与 12 个月内接受阴道镜检查的患者相比，12 个月内未接受阴道镜检查的患者宫颈癌检出率高 3.12 倍（95%CI1.47-6.70）。
结论：在异常结果后 3 个月内接受阴道镜检查的患者与在 3-12 个月内接受阴道镜检查的患者之间，1 年以上的宫颈癌风险无差异。与 12 个月内接受阴道镜检查的患者相比，12 个月内未接受阴道镜检查的患者发生后续宫颈癌的风险更高。
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