Wang Victoria, Lykken Jacquelyn M, Tiro Jasmin A, Perkins Rebecca B, Haas Jennifer S, Werner Claudia, Kobrin Sarah C, Feldman Sarah
Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, the Department of Obstetrics and Gynecology, Boston Medical Center, the Boston University Chobanian and Avedisian School of Medicine, and the Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Population and Data Sciences and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas; the Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Obstet Gynecol. 2025 May 1;145(5):461-468. doi: 10.1097/AOG.0000000000005877. Epub 2025 Mar 6.
To quantify how many patients treated for high-grade cervical dysplasia completed guideline-concordant surveillance.
We retrospectively analyzed patients aged 30-65 treated for high-grade cervical dysplasia (cervical intraepithelial neoplasia 2 or worse) at two PROSPR II METRICS (Population-based Research to Optimize the Screening Process Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations sites) (Massachusetts General Brigham, Parkland Health) from 2010 to 2019. The primary outcome was receipt of two negative co-tests after treatment within 30 months (allowing 6-month scheduling leeway).
Among 3,146 patients treated for high-grade dysplasia, most were aged 30-39 years (Massachusetts General Brigham 58.9%, Parkland Health 60.9%) and had no or few known comorbidities (Massachusetts General Brigham 81.2%, Parkland Health 85.6%). Race and ethnicity, insurance status, and socioeconomic status reflected broader patient population demographics. Only half of the patients (45.5%) completed two surveillance co-tests after treatment within 30 months (Massachusetts General Brigham 55.3%, Parkland Health 40.6%), among whom a third received at least one subsequent abnormal co-test result (Massachusetts General Brigham 30.9%, Parkland Health 31.6%). Patients who completed two co-tests were under observation longer than those who did not complete two co-tests (median Massachusetts General Brigham 64.9 months vs 33.1 months, median Parkland Health 63.9 months vs 41.8 months). Among patients who completed two co-tests, the timing of surveillance co-testing was largely concordant with guidelines (median [interquartile range] time to first co-test: Massachusetts General Brigham 6.4 [5.1-9.2] months, Parkland Health 10.1 [6.6-12.6] months; median [interquartile range] time between first and second co-test: Massachusetts General Brigham 8.5 [6.0-12.6] months, Parkland Health 12.0 [8.0-13.5] months). Overall, 16 patients (0.5%) were diagnosed with cervical cancer after treatment for high-grade dysplasia (median [interquartile range] time from treatment to cancer diagnosis 14.9 [3.8-45.9] months).
Approximately half of patients did not receive guideline-concordant surveillance after treatment for high-grade dysplasia, and one-third had a subsequent abnormal co-test result. Patients with high-grade cervical dysplasia are at elevated risk of subsequent abnormalities and should continue to be closely monitored. Additional systematic monitoring is needed to ensure guideline-compliant surveillance after dysplasia treatment.
量化接受高级别宫颈发育异常治疗的患者中完成符合指南监测的人数。
我们回顾性分析了2010年至2019年在两个PROSPR II METRICS（基于人群的研究以优化筛查过程，不同环境和人群中宫颈癌筛查过程的多层次优化）（马萨诸塞州综合医院布莱根分院、帕克兰健康中心）接受高级别宫颈发育异常（宫颈上皮内瘤变2级或更严重）治疗的30至65岁患者。主要结局是治疗后30个月内接受两次联合检查结果均为阴性（允许有6个月的检查安排宽松期）。
在3146例接受高级别发育异常治疗的患者中，大多数年龄在30至39岁（马萨诸塞州综合医院布莱根分院为58.9%，帕克兰健康中心为60.9%），且已知合并症较少或无合并症（马萨诸塞州综合医院布莱根分院为81.2%，帕克兰健康中心为85.6%）。种族和族裔、保险状况及社会经济地位反映了更广泛的患者群体特征。只有一半的患者（45.5%）在治疗后30个月内完成了两次监测联合检查（马萨诸塞州综合医院布莱根分院为55.3%，帕克兰健康中心为40.6%），其中三分之一至少有一次后续联合检查结果异常（马萨诸塞州综合医院布莱根分院为30.9%，帕克兰健康中心为31.6%）。完成两次联合检查的患者观察时间长于未完成两次联合检查的患者（马萨诸塞州综合医院布莱根分院中位数为64.9个月对33.1个月，帕克兰健康中心中位数为63.9个月对41.8个月）。在完成两次联合检查的患者中，监测联合检查的时间在很大程度上符合指南（第一次联合检查的中位时间[四分位间距]：马萨诸塞州综合医院布莱根分院为6.4[5.1 - 9.2]个月，帕克兰健康中心为10.1[6.6 - 12.6]个月；第一次和第二次联合检查之间的中位时间[四分位间距]：马萨诸塞州综合医院布莱根分院为8.5[6.0 - 12.6]个月，帕克兰健康中心为12.0[8.0 - 13.5]个月）。总体而言，16例患者（0.5%）在接受高级别发育异常治疗后被诊断为宫颈癌（从治疗到癌症诊断的中位时间[四分位间距]为14.9[3.8 - 45.9]个月）。
约一半的患者在接受高级别发育异常治疗后未接受符合指南的监测，三分之一有后续联合检查结果异常。高级别宫颈发育异常患者后续出现异常的风险升高，应继续密切监测。需要额外的系统监测以确保发育异常治疗后符合指南的监测。
