Lu Junling, Han Shichao, Li Ya, Na Jing, Wang Jun
Department of Gynecology and Obstetrics, Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Microbiol. 2023 Oct 6;14:1266254. doi: 10.3389/fmicb.2023.1266254. eCollection 2023.
Persistent human papillomavirus infection is an important factor in the development of cervical cancer, which is usually a long process evolving from the development of squamous intraepithelial lesions (SIL), also referred to as cervical intraepithelial neoplasia (CIN). Local treatment of advanced squamous intraepithelial lesions, also regarded as High-Grade Squamous Intraepithelial Lesion, may be effective in preventing cancer.
To promptly identify high-risk patients with a tendency to recurrence.
We retrospectively analyzed the clinical data of 300 patients with high-grade squamous intraepithelial lesions of the cervix admitted to the Second Affiliated Hospital of Dalian Medical University from 2019 to 2020 to investigate the relationship between recurrence of cervical lesions and postoperative regression of HPV infection, as well as other related risk factors.
We found that the HPV-negative rates were 81.81, 85.71, and 90.91% at 6, 12, and 24 months, respectively, and the average lesion recurrence rate was 8.16%, with a median time to recurrence of 14 months in patients undergoing CKC for HSIL. The risk of cervical squamous intraepithelial lesions was highest in patients with HPV16. Patients over 61 years of age had the lowest postoperative HPV-negative rate. The conversion rate was significantly lower in patients with multiple HPV genotypes than in those with single HPV infection ( < 0.05). The probability of recurrence was higher in patients with the same HPV infection genotype before and after surgery than in patients with different infection genotypes before and after surgery ( < 0.05).
Combined with the literature review, we believe that patients aged ≥50 years, with ≥3 pregnancies and births, a history of smoking, and consistent genotypes of preoperative and postoperative HPV infection in cervical conization have more HPV re-infection or persistent infection, and that these factors may be high-risk factors for lesion recurrence. For patients with possible potential high-risk factors, we need to carry out individualized follow-up and focused management, take timely and effective management measures, optimize the treatment plan, reduce the recurrence rate, prevent HSIL and cervical cancer, improve the quality of patient's survival, and improve the prognosis.
持续性人乳头瘤病毒（HPV）感染是宫颈癌发生发展的重要因素，宫颈癌通常是一个从鳞状上皮内病变（SIL）发展而来的漫长过程，鳞状上皮内病变也称为宫颈上皮内瘤变（CIN）。对高级别鳞状上皮内病变（也称为高级别鳞状上皮内病变）进行局部治疗可能有效预防癌症。
及时识别有复发倾向的高危患者。
回顾性分析2019年至2020年大连医科大学附属第二医院收治的300例宫颈高级别鳞状上皮内病变患者的临床资料，探讨宫颈病变复发与术后HPV感染消退情况以及其他相关危险因素之间的关系。
我们发现，术后6、12和24个月时HPV阴性率分别为81.81%、85.71%和90.91%，平均病变复发率为8.16%，接受冷刀锥切术（CKC）治疗高级别鳞状上皮内病变（HSIL）患者的复发中位时间为14个月。HPV16型患者发生宫颈鳞状上皮内病变的风险最高。61岁以上患者术后HPV阴性率最低。多种HPV基因型患者的转阴率显著低于单一HPV感染患者（P<0.05）。手术前后HPV感染基因型相同的患者复发概率高于手术前后感染基因型不同的患者（P<0.05）。
结合文献复习，我们认为年龄≥50岁、妊娠分娩≥3次、有吸烟史以及宫颈锥切术中术前和术后HPV感染基因型一致的患者有更多HPV再感染或持续感染情况，这些因素可能是病变复发的高危因素。对于可能存在潜在高危因素的患者，我们需要进行个体化随访和重点管理，及时采取有效管理措施，优化治疗方案，降低复发率，预防高级别鳞状上皮内病变和宫颈癌，提高患者生存质量，改善预后。
