Prognostic outcomes and risk factors for recurrence after laser vaporization for cervical intraepithelial neoplasia: a single-center retrospective study
Prognostic outcomes and risk factors for recurrence after laser vaporization for cervical intraepithelial neoplasia: a single-center retrospective study
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DOI：
10.1007/s10147-020-01848-x
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发表时间：
2021-01-04
影响因子：
3.3
通讯作者：
Kato, Kiyoko
中科院分区：
文献类型：
--
作者：
Kodama, Keisuke;Yahata, Hideaki;Kato, Kiyoko
背景宫颈上皮内瘤变(CIN)是一种癌前病变，可在不干预的情况下进展为浸润性宫颈癌。我们旨在研究CIN 3、CIN 2合并高危人乳头瘤病毒(HPV)感染、CIN 1持续2年以上患者激光汽化术后的预后和复发危险因素。方法从2008年到2016年，共有1070名患者接受了使用二氧化碳激光的宫颈激光汽化手术。我们对他们的病历进行了回顾，以评估他们的临床特征、病理因素和预后。结果患者年龄18~，平均34岁。术前诊断为CIN 1 27例，CIN 2 485例，CIN 3 558例。中位随访15个月，2年复发率18.9%，5年复发率46.5%。2年复治率为12.6%，5年复治率为30.5%。治疗后诊断为浸润性癌9例，所有患者均接受多学科联合治疗，随访期间无死亡病例。无复发间期与患者年龄(危险比，1.028；95%CI 1.005~1.051；P=0.0167)、体重指数(HR，1.052；95%CI 1.008~1.098；P=0.0191)、腺体受累(HR，1.962；95%CI 1.353~2.846；P=0.0004)相关。结论宫颈激光汽化术对希望保留生育能力的宫颈上皮内瘤变患者是有效的。然而，腺体受累、年龄较大和体重较高的患者需要密切随访以防止复发。
Background Cervical intraepithelial neoplasia (CIN) is a precancerous lesion that may progress to invasive cervical cancer without intervention. We aim to examine the prognostic outcomes and risk factors for recurrence after laser vaporization for CIN 3, CIN 2 with high-risk human papillomavirus (HPV) infection, and CIN 1 persisting for more than 2 years. Methods Between 2008 and 2016, a total of 1070 patients underwent cervical laser vaporization using a carbon dioxide laser. We performed a retrospective review of their medical records to assess their clinical characteristics, pathologic factors, and prognostic outcomes. Results The mean patient age was 34 years (range 18-64 years). The preoperative diagnosis was CIN 1 in 27 patients, CIN 2 in 485 patients, and CIN 3 in 558 patients. Over a median follow-up period of 15 months, the 2-year recurrence rate was 18.9%, and the 5-year recurrence rate was 46.5%. The 2-year retreatment rate was 12.6%, and the 5-year retreatment rate was 30.5%. We diagnosed 9 patients with invasive cancer after treatment; all patients underwent combined multidisciplinary treatment, and there were no deaths during follow-up. The recurrence-free interval was correlated with patient age (hazard ratio [HR], 1.028; 95% CI 1.005-1.051; P = 0.0167), body mass index (HR, 1.052; 95% CI 1.008-1.098; P = 0.0191), and glandular involvement (HR, 1.962; 95% CI 1.353-2.846; P = 0.0004). Conclusions Cervical laser vaporization is effective and useful for patients with CIN who wish to preserve fertility. However, patients with glandular involvement, older age, and higher body weight require close follow-up for recurrence.