Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization
Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization
复制标题
DOI：
10.1016/s0090-8258(03)00268-3
复制
发表时间：
2003-08-01
影响因子：
4.7
通讯作者：
Syrjdnen, K
中科院分区：
文献类型：
--
作者：
Costa, S;De Simone, P;Syrjdnen, K
Objective.目的是确定可能预测CIN治疗的长期结果和局部切除治疗后HPV清除/持续的因素（如果有的话）。一系列的252名女性CIN病变锥切治疗进行了连续的HPV检测重复PCR在前瞻性治疗后随访。预测随访期间（10.26个月）病毒清除的因素采用单变量和多变量统计技术，应用于病变的流行病学、临床和生物学数据。PAP检测高级别病变的敏感性为93.9%，特异性为27.3%。HSIL PAP试验锥段中CIN 3/IAl期宫颈鳞癌的比值比为5.69; PCR阳性和阴性病例中分别发现77.8%和22.2%的残留病变。首次PCR检测HPV DNA阴性率为29.8%（74/252）。多因素Logistic回归分析显示HPV 16是高度CIN的独立解释因素（P = 0.0001）。完成随访时HPV清除率增加至63.5%，相当于每月清除率5.27%。在Kaplan-Meier分析中，HPV清除/持续性的高度显著（P = 0.0001）预测因素是年龄、活检病变分级、锥状病变分级、锥状病变体积、活跃性生活时间和宫颈内边缘受累（P = 0.0013）。在卡方检验中，高危型HPV（P = 0.001）是这种预测因子。在多因素（考克斯）模型中，HPV清除率的独立预测因素为宫颈边缘（P = 0.001）、宫颈锥部病变分级（P = 0.004）、阴道镜活检高级别病变（P = 0.023）、年龄（P = 0.029）和宫颈涂片HSIL（P = 0.029）。这些数据表明，治疗后随访应包括PAP试验和HPV检测技术，以早期发现任何患者的疾病复发和进展的风险增加，因为持续的致癌HPV类型。(C)2003 Elsevier Science（美国）。All rights reserved.
Objective. The objective was to identify the factors, if any, that may predict long-term results of CIN treatment and HPV clearance/persistence after locally excisional therapy.Methods. A series of 252 women with CIN lesions treated by conization were subjected to sequential HPV detection by repeated PCR during the prospective posttreatment follow-up. Factors predicting viral clearance during the follow-up (10.26 months) were elaborated using univariate and multivariate statistical techniques applied on epidemiological, clinical and biological data of the lesions.Results. Sensitivity of the PAP test in detecting high-grade lesions was 93.9%, and specificity 27.3%. Odds ratio for having CIN 3/Stage IAl squamous cervical cancer in the cone with HSIL PAP test was 5.69; 77.8 and 22.2% residual disease were found among PCR-positive and -negative cases, respectively. HPV DNA was negative in 74/252 (29.8%) samples at the first PCR. Multivariate logistic regression analysis showed that HPV 16 was an independent explanatory factor for high-grade CIN (P = 0.0001). HPV clearance increased to 63.5% at completion of the follow-up, corresponding to the monthly clearance rate of 5.27%. In Kaplan-Meier analysis, the highly significant (P = 0.0001) predictors of HPV clearance/persistence were age, lesion grade in the biopsy, lesion grade in the cone, volume of the cone, length of active sexual life, and involvement of endocervical margin (P = 0.0013). In chi-square tests, high-risk HPV type (P = 0.001) was such a predictor. In multivariate (Cox) model, the significant independent predictors of HPV clearance were involved endocervical margin (P = 0.001), lesion grade in the cone (P = 0.004), high-grade lesion in the colposcopic biopsy (P = 0.023), age (P = 0.029), and HSIL in PAP smear (P = 0.029).Conclusions. These data suggest that posttreatment follow-up should include both the PAP test and HPV detection techniques for early detection of any patients at increased risk for disease recurrence and progression, because of persistent oncogenic HPV types. (C) 2003 Elsevier Science (USA). All rights reserved.