Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study
Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study
复制标题
DOI：
10.1136/bmj.e6855
复制
发表时间：
2012-11-01
影响因子：
105.7
通讯作者：
van Ballegooijen, Marjolein
中科院分区：
文献类型：
--
作者：
Rebolj, Matejka;Helmerhorst, Theo;van Ballegooijen, Marjolein
目的比较组织学证实宫颈上皮内瘤变的妇女在完成治疗后随访并连续涂片检查结果正常后返回常规筛查与原发涂片检查结果正常的妇女发生宫颈癌的风险。设计基于人群的队列研究，使用来自全国病理登记的数据。设置荷兰，1994年至2006年。人群38956名经组织学证实为1至3级上皮内瘤变的妇女，治疗后完成随访。干预：宫颈上皮内瘤变的常规治疗后随访，建议在6、12和24个月进行涂片检查。主要观察指标：从宫颈上皮内瘤变术后检查结果为阴性的随访结束至下一次初次检查期间宫颈癌的发病率。将10年风险比与初次涂片检查结果正常后的时期进行比较，并根据随访年份进行调整。结果在宫颈上皮内瘤变随访完成后的56 956年中，诊断出20例宫颈癌，而在原发涂片检查结果正常后的25 020 697年中，诊断出1613例宫颈癌。每10万女性年的发病率分别为35.1（95%置信区间21.4至54.2）和6.4(95%置信区间6.1至6.8)，导致完成随访后与正常原发性涂片检查结果后的调整风险比为4.2（95%置信区间2.7至6.5）。这一风险比在所有年龄段都有所增加。宫颈上皮内瘤变的分级对宫颈癌的危险性无显著差异。结论：在宫颈上皮内瘤变治疗的妇女中，先前观察到的宫颈癌风险过高，在完成治疗后随访并连续三次涂片检查结果正常的妇女亚组中也观察到。与原始涂片检查结果正常的妇女（每10万妇女年6例）相比，这些妇女患宫颈癌的总体校正风险增加了4倍（每10万妇女年35例）。
Objective To compare the risk of cervical cancer in women with histologically confirmed cervical intraepithelial neoplasia who returned to routine screening after having completed post-treatment follow-up with consecutive normal smear test results with women with a normal primary smear test result.Design Population based cohort study using data from a nationwide pathology register.Setting The Netherlands, 1994 to 2006.Population 38 956 women with histologically confirmed intraepithelial neoplasia grades 1 to 3 with completed follow-up after treatment.Intervention Routine post-treatment follow-up of cervical intraepithelial neoplasia, recommending smear tests at six, 12, and 24 months.Main outcome measure Incidence of cervical cancer in the period from completed follow-up with negative test results after cervical intraepithelial neoplasia to the next primary test. 10-year hazard ratios were compared with periods after normal results for the primary smear test, adjusted for year in follow-up.Results 20 cervical cancers were diagnosed during 56 956 woman years after completed follow-up of cervical intraepithelial neoplasia, whereas 1613 cervical cancers were diagnosed during 25 020 697 woman years after a normal primary smear test result. The incidence of 35.1 (95% confidence interval 21.4 to 54.2) per 100 000 woman years and 6.4 (6.1 to 6.8) per 100 000 woman years, respectively, led to an adjusted hazard ratio of 4.2 (95% confidence interval 2.7 to 6.5) for periods after completed follow-up compared with periods after normal primary smear test results. This hazard ratio was increased for all ages.No significant difference in risk of cervical cancer was observed by grade of cervical intraepithelial neoplasia.Conclusions An excess risk of cervical cancer previously observed for women treated for cervical intraepithelial neoplasia was also observed in the subgroup of women who completed their post-treatment follow-up with three consecutive normal smear test results. The overall corrected risk of cervical cancer in these women was increased fourfold 35 cases per 100 000 woman years) compared with women with normal primary smear test results (6 per 100 000 woman years).