Clarke Megan A, Befano Brian, Wentzensen Nicolas, Cheung Li C, Egemen Didem, Castle Philip E, Schiffman Mark, Goldhoff Patricia E, Seo Tracy S, Suh-Burgmann Elizabeth J, Poitras Nancy, Fuller Laurie A, Wi Soora, Lorey Thomas, Shah Nina R
Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD.
Information Management Services, Calverton, MD; Department of Epidemiology, University of Washington, Seattle, WA.
Am J Obstet Gynecol. 2025 Jul;233(1):40.e1-40.e16. doi: 10.1016/j.ajog.2024.12.002. Epub 2024 Dec 6.
Individuals with obesity have an increased risk of cervical cancer, in part related to challenges associated with cervical sampling and visualization that result in missed detection of cervical precancers. The influence of obesity on the effectiveness of excisional treatment of detected cervical precancers and posttreatment disease risk is unknown.
The aim of this study was to evaluate posttreatment risks of cervical precancer and cancer by body mass index (BMI).
This retrospective cohort study included individuals aged 25 years and older undergoing excisional treatment for cervical precancer, either cervical intraepithelial neoplasia (CIN) grade 2 or 3 or adenocarcinoma in situ as of January 2017 with follow-up through February 2023. Patients were excluded if they were missing BMI, had cancer upon excision or had hysterectomy in lieu of excision, or were missing a valid referral screening visit. We categorized BMI as follows: underweight/normal (<25 kg/m), overweight (25 to <30 kg/m), and obesity (≥30kg/m), as well as by class (I-III) of obesity. We calculated 2-year risks of CIN3 and cancer (combined as CIN3+) using Kaplan Meier methods and evaluated multivariable adjusted associations of BMI with CIN3+ using Cox Proportional Hazards regression analyses, accounting for age at treatment, race and ethnicity, and treatment type.
Among 10,614 patients, a total of 680 (6.4%) developed post-treatment CIN3+; most (91%) within 2 years of treatment. Two-year CIN3+ and cancer risks were highest in those with obesity (8.65%, 95% CI, 7.6%-9.9% and 0.79%, 95% CI, 0.5%-1.2%, respectively) and lowest in those with normal weight (5.57%, 95% CI, 4.9%-6.3% and 0.29%, 95% CI, 0.2%-0.5%, respectively). Hazard ratios measuring associations of BMI with risk of posttreatment CIN3+ ranged from 1.19 (95% CI, 1.0-1.4) among those with overweight to 1.89 (95% CI, 1.4-2.6) among those with class III obesity (P-trend<.0001). A similar trend was observed for cancer, from 1.62 (95% CI, 0.8-3.3) for overweight and 3.50 (95% CI, 1.3-9.3) for class III obesity (P-trend=.016).
Patients with obesity undergoing excisional treatment for cervical precancer have a higher risk of residual or recurrent disease, likely due to incomplete excision.
肥胖个体患宫颈癌的风险增加，部分原因与宫颈取样和可视化方面的挑战有关，这些挑战会导致宫颈癌前病变漏诊。肥胖对已检测出的宫颈癌前病变切除治疗效果及治疗后疾病风险的影响尚不清楚。
本研究旨在按体重指数（BMI）评估宫颈上皮内瘤变和宫颈癌的治疗后风险。
这项回顾性队列研究纳入了2017年1月起接受宫颈上皮内瘤变2级或3级或原位腺癌切除治疗的25岁及以上个体，并随访至2023年2月。若患者缺失BMI数据、切除时已患癌症、接受子宫切除术而非切除术，或缺失有效的转诊筛查就诊记录，则被排除。我们将BMI分类如下：体重过轻/正常（<25kg/m²）、超重（25至<30kg/m²）和肥胖（≥30kg/m²），以及按肥胖等级（I - III级）分类。我们使用Kaplan - Meier方法计算CIN3和癌症（合并为CIN3 +）的2年风险，并使用Cox比例风险回归分析评估BMI与CIN3 +的多变量调整关联，同时考虑治疗时的年龄、种族和民族以及治疗类型。
在10614名患者中，共有680名（6.4%）出现治疗后CIN3 +；大多数（91%）在治疗后2年内出现。肥胖患者的2年CIN3 +和癌症风险最高（分别为8.65%，95%CI，7.6% - 9.9%和0.79%，95%CI，0.5% - 1.2%），体重正常者风险最低（分别为5.57%，95%CI，4.9% - 6.3%和0.29%，95%CI，0.2% - 0.5%）。衡量BMI与治疗后CIN3 +风险关联的风险比范围从超重者的1.19（95%CI，1.0 - 1.4）到III级肥胖者的1.89（95%CI，1.4 - 2.6）（P趋势<.0001）。癌症方面也观察到类似趋势，超重者为1.62（95%CI，0.8 - 3.3），III级肥胖者为3.50（95%CI，1.3 - 9.3）（P趋势=.016）。
接受宫颈上皮内瘤变切除治疗的肥胖患者残留或复发疾病的风险较高，可能是由于切除不完全所致。
