Department of Obstetrics and Gynecology, Yuai-Medical Center, Tomishiro 901-0224, Okinawa, Japan.
Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan.
Viruses. 2023 Nov 7;15(11):2219. doi: 10.3390/v15112219.
This study aimed to validate the use of liquid phenol-based chemical peeling therapy for cervical and vaginal intraepithelial neoplasia (CIN and VaIN, respectively), with the goal of circumventing obstetric complications associated with surgical treatment and to determine the factors associated with treatment resistance. A total of 483 eligible women diagnosed with CIN, VaIN, or both, participated in this study. Participants underwent phenol-based chemical peeling therapy every 4 weeks until disease clearance. Disease clearance was determined by negative Pap tests for four consecutive weeks or by colposcopy. HPV genotyping was conducted at the onset of the study and after disease clearance in select cases. Our preliminary analysis compared the recurrence and persistence rates between 294 individuals who received phenol-based chemical peeling therapy and 189 untreated patients. At 2 years following diagnosis, persistent disease was observed in 18%, 60%, and 88% of untreated patients with CIN1-3, respectively, and <2% of patients with CIN who received phenol-based chemical peeling therapy. Among 483 participants, 10 immune-suppressed patients required multiple treatments to achieve disease clearance, and 7 were diagnosed with cervical cancer. Of the 466 participants, except those with cancer or immune suppression, the number of treatment sessions until CIN/VaIN clearance ranged from 2 to 42 (average: 9.2 sessions). In total, 43 participants (9.2%) underwent surgical treatment. Six patients (1.3%) experienced recurrence of CIN2 or worse, suggesting that treatment failed in 46 patients (9.9%). No obstetrical complications were noted among the 98 pregnancies following this therapy. Factors associated with resistance to this therapy include immune suppression, ages 35-39 years, higher-grade lesions, and multiple HPV-type infections. Phenol-based therapy is safe and effective for CINs and VaINs. Women aged < 35 years and with persistent CIN1 or CIN2 with a single HPV-type infection are suitable candidates for phenol-based chemical peeling therapy. However, this therapy requires multiple lengthy sessions.
本研究旨在验证液态苯酚化学剥脱疗法在治疗宫颈和阴道上皮内瘤变(分别为 CIN 和 VaIN)中的应用,以避免手术治疗相关的产科并发症,并确定与治疗抵抗相关的因素。共有 483 名符合条件的 CIN、VaIN 或两者均被诊断的女性参与了这项研究。参与者每 4 周接受一次苯酚化学剥脱治疗,直到疾病清除。疾病清除通过连续 4 周阴性的巴氏涂片检查或阴道镜检查来确定。HPV 基因分型在研究开始时和在某些情况下清除疾病后进行。我们的初步分析比较了 294 名接受苯酚化学剥脱治疗的患者和 189 名未接受治疗的患者之间的复发率和持续率。在诊断后 2 年,未接受治疗的 CIN1-3 患者中分别有 18%、60%和 88%持续存在疾病,而接受苯酚化学剥脱治疗的患者中<2%持续存在疾病。在 483 名参与者中,有 10 名免疫抑制患者需要多次治疗才能清除疾病,7 名被诊断为宫颈癌。除了癌症或免疫抑制的 466 名参与者外,CIN/VaIN 清除所需的治疗次数范围为 2 至 42(平均:9.2 次)。共有 43 名参与者(9.2%)接受了手术治疗。6 名患者(1.3%)出现 CIN2 或更高级别病变的复发,这表明 46 名患者(9.9%)的治疗失败。在接受这种治疗后,98 例妊娠中没有出现产科并发症。对这种治疗有抵抗力的因素包括免疫抑制、年龄 35-39 岁、更高级别的病变和多种 HPV 型感染。苯酚化学剥脱疗法对 CIN 和 VaIN 是安全有效的。年龄<35 岁且持续存在单一 HPV 型感染的 CIN1 或 CIN2 的女性是苯酚化学剥脱治疗的合适人选。然而,这种治疗需要多次漫长的疗程。