Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark.
NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark.
JAMA Netw Open. 2024 Mar 4;7(3):e242309. doi: 10.1001/jamanetworkopen.2024.2309.
Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) is being implemented in many high-income countries due to the association of excisional treatment with preterm birth. However, it is unknown whether active surveillance results in lower risk of preterm birth given that cervical dysplasia itself is associated with higher risk of preterm birth.
To compare the preterm birth risk between women with CIN2 undergoing active surveillance or immediate loop electrosurgical excision procedure (LEEP).
DESIGN, SETTING, AND PARTICIPANTS: This historical population-based cohort study included women with a first-time diagnosis of CIN2 and a subsequent singleton birth from 1998 to 2018 in Denmark. Women with prior CIN grade 3 or greater or LEEP were excluded. Data were collected from 4 Danish health care registries. Analyses were conducted from October 2022 to June 2023.
Women were categorized into active surveillance (cervical biopsy and/or cytology) or immediate LEEP based on their first cervical sample after CIN2 diagnosis. The active surveillance group was further subdivided based on whether a delayed LEEP was performed within 28 months from CIN2 diagnosis.
Risk of preterm birth (<37 + 0 weeks) was assessed and relative risks (RRs) were calculated using modified Poisson regression. Analyses used inverse probability treatment weighting of the propensity scores to adjust for age, parity, calendar year, index cytology, and smoking.
A total of 10 537 women with CIN2 and a singleton birth were identified; 4430 (42%) underwent active surveillance and 6107 (58%) were treated with immediate LEEP. For both groups, most were aged 23 to 29 years at CIN2 diagnosis (3125 [70%] and 3907 [64%], respectively). Overall, 869 births (8.2%) were preterm. The risk of preterm birth was comparable between active surveillance and immediate LEEP (RR, 1.03; 95% CI, 0.90-1.18). However, for women undergoing delayed LEEP after active surveillance (1539 of the active surveillance group [35%]), the risk of preterm birth was higher than for women treated with immediate LEEP (RR, 1.29; 95% CI, 1.08-1.55).
In this cohort study of women with CIN2, the risk of preterm birth was comparable between active surveillance and immediate LEEP. However, delayed LEEP was associated with 30% higher risk of preterm birth than immediate LEEP. Thus, risk stratification at CIN2 diagnosis is important to identify women with increased risk of delayed LEEP.
由于切除治疗与早产有关，许多高收入国家正在对宫颈上皮内瘤变 2 级（CIN2）进行主动监测。然而，鉴于宫颈发育不良本身与早产风险增加有关，主动监测是否会降低早产风险尚不清楚。
比较 CIN2 女性接受主动监测或即刻环形电切术（LEEP）的早产风险。
设计、地点和参与者：这是一项基于人群的历史性队列研究，纳入了 1998 年至 2018 年期间丹麦首次诊断为 CIN2 且随后分娩单胎的女性。排除了先前有 CIN3 级或更高级别或 LEEP 的女性。数据来自 4 个丹麦医疗保健登记处。分析于 2022 年 10 月至 2023 年 6 月进行。
根据 CIN2 诊断后首次宫颈样本，女性被分为主动监测（宫颈活检和/或细胞学）或即刻 LEEP。主动监测组根据是否在 CIN2 诊断后 28 个月内进行延迟 LEEP 进一步细分。
评估早产风险（<37+0 周），并使用改良泊松回归计算相对风险（RR）。分析使用倾向评分的逆概率治疗加权来调整年龄、产次、日历年份、指数细胞学和吸烟情况。
共确定了 10537 名患有 CIN2 且分娩单胎的女性；4430 名（42%）接受了主动监测，6107 名（58%）接受了即刻 LEEP 治疗。对于两组，大多数女性在 CIN2 诊断时年龄在 23 至 29 岁（分别为 3125 [70%]和 3907 [64%]）。总体而言，869 例（8.2%）分娩早产。主动监测和即刻 LEEP 之间的早产风险相当（RR，1.03；95%CI，0.90-1.18）。然而，对于接受主动监测后行延迟 LEEP 的女性（主动监测组 1539 例[35%]），其早产风险高于即刻 LEEP 组（RR，1.29；95%CI，1.08-1.55）。
在这项 CIN2 女性的队列研究中，主动监测与即刻 LEEP 之间的早产风险相当。然而，延迟 LEEP 与即刻 LEEP 相比，早产风险增加 30%。因此，在 CIN2 诊断时进行风险分层对于识别有延迟 LEEP 风险增加的女性很重要。
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