Natural history of dysplasia of the uterine cervix
Natural history of dysplasia of the uterine cervix
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DOI：
10.1093/jnci/91.3.252
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发表时间：
1999-02-03
影响因子：
10.3
通讯作者：
To, T
中科院分区：
文献类型：
--
作者：
Holowaty, P;Miller, AB;To, T
背景资料：一个历史队列的多伦多（安大略，加拿大）妇女的巴氏涂片的历史记录在一个主要的细胞病理学实验室提供了一个机会，研究进展和退化的宫颈不典型增生的时代（1962-1980年），在此期间，宫颈鳞状病变保守治疗。研究方法：采用精算和考克斯生存分析来估计轻症患者进展和消退的比率和相对风险。此外，在1970年至1980年（含）之间有子宫颈抹片检查史并被诊断为轻度，中度，或严重不典型增生与安大略癌症登记处1989年发生的任何后续宫颈癌的结果有关。结果：轻度和中度发育不良更容易退化，而不是进展。从轻度发育不良进展到重度发育不良或更严重的风险每年仅为1%，但从中度发育不良进展的风险在2年内为16%，在5年内为25%。大多数重度和中度异型增生的宫颈癌额外风险发生在初次异型增生涂片检查的2年内。2次Sears后，与轻度异型增生相比，从重度或中度异型增生进展为宫颈原位癌或更严重的相对风险分别为4.2（95% CI = 3.0-5.7）和2.5（95% CI = 2.2-3.0）。结论：中度异型增生的进展风险介于轻度和重度异型增生的风险之间;因此，中度类别可能代表临床上有用的区别。大多数未经治疗的轻度发育不良记录为在2年内消退以产生正常涂片。
Background: A historical cohort of Toronto (Ontario, Canada) women whose Pap smear histories were recorded at a major cytopathology laboratory provided the opportunity to study progression and regression of cervical dysplasia in an era (1962-1980) during which cervical squamous lesions were managed conservatively. Methods: Actuarial and Cox's survival analyses were used to estimate the rates and relative risks of progression and regression of mild (cervical intraepithelial neoplasia 1 [CIN1]) and moderate (CIN2) dysplasias, In addition, more than 17 000 women with a history of Pap smears between 1970 and 1980 inclusive and who were diagnosed as having mild, moderate, or severe dysplasia were linked to the Ontario Cancer Registry for the outcome of any subsequent cervical cancers occurring through 1989. Results: Both mild and moderate dysplasias were more likely to regress than to progress. The risk of progression from mild to severe dysplasia or worse was only 1% per year, but the risk of progression from moderate dysplasia was 16% within 2 years and 25% within 5 years. Most of the excess risk of cervical cancer for severe and moderate dysplasias occurred within 2 years of the initial dysplastic smear. After 2 Sears, in comparison with mild dysplasia, the relative risks for progression from severe or moderate dysplasia to cervical cancer in situ or worse was 4.2 (95% confidence interval [CI] 3.0-5.7) and 2.5 (95% CI = 2.2-3.0), respectively. Conclusion: The risk of progression for moderate dysplasia was intermediate between the risks for mild and severe dysplasia; thus, the moderate category may represent a clinically useful distinction. The majority of untreated mild dysplasias were recorded as regressing to yield a normal smear within 2 years.