Global Medical and Scientific Affairs, MSD Sharp & Dohme GmbH, Munich, Germany.
Global Medical and Scientific Affairs, MSD, Rome, Italy.
Eur J Obstet Gynecol Reprod Biol. 2024 Sep;300:129-140. doi: 10.1016/j.ejogrb.2024.06.030. Epub 2024 Jul 1.
High-grade cervical intraepithelial neoplasia (CIN), a premalignant lesion of the uterine cervix, is caused by persistent Human Papillomavirus (HPV) infection. CIN can be identified through screening programs and high-grade CIN is usually treated by ablation or excision. This study aimed to summarize the clinical management and outcomes among women with high-grade CIN in Europe.
A systematic literature review was conducted to identify treatment methods and their frequency of use, report HPV genotype prevalence and distribution and summarize patterns for subsequent lesions after primary treatment, among women with high-grade CIN in Europe. Embase®, MEDLINE® and Cochrane databases were searched (1st January 2012 to 30th August 2022), along with relevant conference proceedings (2018-2022), inclusive. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliant methodology was adopted. Eligibility criteria included non-immunosuppressed female patients with CIN2+ from Europe (published in English).
In total, n = 55 studies were included. CIN excisional therapy was the most received treatment approach (15.8-100 %, loop electrosurgical excision procedure/large loop excision of the transformation zone most common), followed by ablative therapies (1-43.3 %, cold coagulation most common). Other approaches included 'wait and watch' (4.8-52.6 %) and hysterectomy (4.8-16.2 %). HPV positivity rates ranged from 67.8-100 % pre-conization and 4.7-32.8 % post-conization. The most prevalent HPV genotypes reported (both pre- and post-treatment) were HPV16 and HPV18. In patients who received excisional or ablative procedures subsequent CIN was most frequently diagnosed ≤6 months after treatment. The overall rate of subsequent CIN reported was 0.5-20.9 %.
Conization and ablation were the most common techniques, however, these procedures were associated with sub-optimal outcomes. Close clinical follow-up is important due to the risk of subsequent CIN or invasive cancer. This review serves as a reference point for the comparison of future treatment patterns as they evolve across Europe, following improved implementation of prophylactic HPV vaccination and screening.
高级别宫颈上皮内瘤变（CIN）是子宫颈的癌前病变，由持续性人乳头瘤病毒（HPV）感染引起。CIN 可以通过筛查计划发现，高级别 CIN 通常通过消融或切除治疗。本研究旨在总结欧洲高级别 CIN 患者的临床管理和结局。
进行了系统的文献综述，以确定治疗方法及其使用频率，报告 HPV 基因型的流行率和分布，并总结原发性治疗后后续病变的模式，纳入欧洲高级别 CIN 女性患者。检索了 Embase®、MEDLINE® 和 Cochrane 数据库（2012 年 1 月 1 日至 2022 年 8 月 30 日），以及相关会议论文集（2018-2022 年），采用符合系统评价和荟萃分析首选报告项目（PRISMA）的方法学。纳入标准包括来自欧洲的非免疫抑制女性 CIN2+患者（以英文发表）。
共纳入 55 项研究。CIN 切除术是最常用的治疗方法（15.8-100%，环电切除术/转化区大切除术最常见），其次是消融疗法（1-43.3%，冷凝术最常见）。其他方法包括“等待观察”（4.8-52.6%）和子宫切除术（4.8-16.2%）。宫颈锥切术前 HPV 阳性率为 67.8-100%，宫颈锥切术后 HPV 阳性率为 4.7-32.8%。报告的最常见 HPV 基因型（术前和术后）为 HPV16 和 HPV18。接受切除术或消融术的患者中，治疗后≤6 个月诊断出后续 CIN 的频率最高。报告的后续 CIN 总发生率为 0.5-20.9%。
宫颈锥切术和消融术是最常用的技术，但这些方法的结局并不理想。由于随后发生 CIN 或浸润性癌的风险，密切的临床随访很重要。本综述为未来随着预防性 HPV 疫苗接种和筛查的广泛应用，在欧洲比较治疗模式的演变提供了参考。
