Ehlers Ulrike, Hoischen Lars, Stalp Jan Lennart, Hachenberg Jens, Ramachandran Dhanya, Brüning Bianca, Jentschke Matthias, Hillemanns Peter, Denecke Agnieszka
Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Germany.
Department of Sociology, Leibniz University, Hannover, Germany.
Arch Gynecol Obstet. 2025 Jul 8. doi: 10.1007/s00404-025-08097-1.
In recent years, active surveillance has been introduced as an alternative to excisional treatment in younger women with cervical intraepithelial neoplasia grade 2 (CIN 2) because spontaneous regression rate is high and excisional treatment is associated with an increased risk of preterm birth. However, the potential effect of this conservative approach on the risk of developing cervical cancer has not been evaluated very well.
The present study offers a real-life analysis of treatment pathways for patients diagnosed with CIN 2.
Following CIN 2 diagnosis, 84 cases out of 187 (44.9%) were managed conservatively for at least 7 months and 103 cases (55.1%) were admitted for an excisional procedure LEEP (loop electrosurgical excision procedure). Out of 84 patients observed with a CIN 2 diagnosis, 64 showed persistence of CIN 2 lesion (76.2%), 14 showed spontaneous remission under active surveillance (16.7%), 4 progressed to CIN 3 (4.8%) and 2 to carcinoma (one case of vaginal carcinoma and one case of cervical adenocarcinoma (Supplementary Fig. 1) (2.4%). We observed the regression of CIN 2 in 16.7% of patients on active surveillance and this was statistically significant during the observation period (95% CI 5.72-10.85, p < 0.001) (Supplementary Fig. 3).
The choice of treatment was strongly associated with HPV typing in our study. Patients with HPV 16 infection underwent surgery more often than patients without HPV 16 infection. The difference in our study was statistically significant (p < 0.001). We observed regression of CIN 2 in 16.7% of patients on active surveillance and this was statistically significant to the observation period (95% CI 5.72-10.85, p < 0.001).
近年来，对于年轻的宫颈上皮内瘤变2级（CIN 2）女性患者，主动监测已被引入作为切除治疗的替代方案，因为自发消退率较高，且切除治疗与早产风险增加相关。然而，这种保守方法对宫颈癌发生风险的潜在影响尚未得到很好的评估。
本研究对诊断为CIN 2的患者的治疗途径进行了真实情况分析。
在诊断为CIN 2后，187例患者中有84例（44.9%）接受了至少7个月的保守治疗，103例（55.1%）接受了切除手术——环形电切术（LEEP）。在84例诊断为CIN 2的观察患者中，64例CIN 2病变持续存在（76.2%），14例在主动监测下自发缓解（16.7%），4例进展为CIN 3（4.8%），2例进展为癌（1例阴道癌和1例宫颈腺癌（补充图1）（2.4%）。我们观察到16.7%接受主动监测的患者CIN 2出现消退，在观察期内这具有统计学意义（95%置信区间5.72 - 10.85，p < 0.001）（补充图3）。
在我们的研究中，治疗选择与HPV分型密切相关。HPV 16感染患者比未感染HPV 16的患者更常接受手术。我们研究中的差异具有统计学意义（p < 0.001）。我们观察到16.7%接受主动监测的患者CIN 2出现消退，在观察期内这具有统计学意义（95%置信区间5.72 - 10.85，p < 0.001）。
