Project 2

项目2

• 批准号: 8935185
• 负责人: DARRON R BROWN
• 金额: $ 16.5万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-19 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8935185
• 关键词: AIDS/HIV problem; Acetic Acids; Adopted; Algorithms; Biopsy; Carcinoma; Cells; Cervical; Cervical Cancer Screening; Cervical Intraepithelial Neoplasia; Cervix Neoplasms; Cessation of life; Coagulation Process; Cold Therapy; Colposcopy; Conization; Consensus; Country; Development; Diagnosis; Educational process of instructing; Excision; Failure; Frequencies; HIV; HIV Infections; Health Services Accessibility; Histologic; Histology; Hospital Referrals; Human Papillomavirus; Hysterectomy; Income; Institutes; Kenya; Knowledge; Laser vaporization; Lesion; Life; Loop electrosurgical excision procedure; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modality; Modeling; Oncogenic; Pap smear; Patients; Population; Premalignant; Prevalence; Recommendation; Recurrence; Research; Resources; Risk; Risk Factors; Testing; Translating; Treatment Failure; Treatment outcome; Visit; Visual; Woman; base; cervical cancer prevention; clinical care; cohort; cost; experience; follow-up; high risk; oncology; prevent; programs; screening; standard of care

Project 2 In 2008,' cervical cancer was responsible for 275,000 deaths, of which about 88% occurred in low- and middle-income countries (LMIC) (1,2). Cervical cancer is the third most common cancer in women worldwide and the most common cancer in many LMIC. In most cases, there is a slow progression from atypical cells to cervical intraepithelial neoplasia (CIN) to invasive carcinoma. Precancerous lesions can be treated and invasive cervical cancer be prevented. The screening methods currently available include cytological smears (Pap smear), visual inspection with acetic acid (VIA), and human papillomavirus (HPV) testing. A diagnosis of CIN can be confirmed by histology (biopsy), with or without colposcopy. There are also many treatment methods that are available, including cryotherapy, LEEP/ large loop excision of the transformation zone(LLETZ), cold knife conization (CKC), laser vaporization, cold coagulation, and hysterectomy. Many resource-limited countries have adopted a "single visit" or "screen-and-treat" approach using cryotherapy following a positive screening test. Cryotherapy has become the initial mode of treatment because of its feasibility and the limited availability of colposcopy/biopsy/LEEP. HIV has been shown to increase the risk of the development, progression and recurrence of CIN (3-5). Several studies have consistently shown that HIV-infected women present higher risk of CIN persistence or recurrence after standard therapy (6-14). In settings where LEEP is available and accessible, treatment with LEEP over cryotherapy is recommended by the WHO. This recommendation applies to women regardless of HIV status. However, there is a paucity of studies assessing the efficacy of cryotherapy or LEEP and the factors associated with successful treatment outcomes among HIV-infected women in LMIC. Moreover, there is no consensus in the treatment specifically for HIV-infected women in LMIC. The core objective of this application is to increase our knowledge about the efficacy of different treatment modalities for precancerous lesions which can help inform the implementation of the best treatment algorithms particularly for HIV-infected women with cervical neoplasia in LMIC.

项目2 2008 年，宫颈癌导致 275,000 人死亡，其中约 88% 发生在低收入和中等收入国家 (LMIC) (1,2)。宫颈癌是全球女性第三大常见癌症，也是许多中低收入国家最常见的癌症。在大多数情况下，从非典型细胞到宫颈上皮内瘤变（CIN）再到浸润性癌的进展缓慢。可以治疗癌前病变并预防浸润性宫颈癌。目前可用的筛查方法包括细胞学涂片（巴氏涂片）、醋酸目视检查（VIA）和人乳头瘤病毒（HPV）检测。 CIN 的诊断可以通过组织学（活组织检查）来确诊，无论是否使用阴道镜检查。可用的治疗方法也很多，包括冷冻疗法、LEEP/转化区大环切除术（LLETZ）、冷刀锥切术（CKC）、激光汽化、冷凝和子宫切除术。 许多资源有限的国家在筛查测试呈阳性后采用了冷冻疗法的“单次就诊”或“筛查和治疗”方法。由于冷冻疗法的可行性以及阴道镜检查/活检/LEEP 的可用性有限，冷冻疗法已成为最初的治疗方式。 HIV 已被证明会增加 CIN 发生、进展和复发的风险 (3-5)。多项研究一致表明，HIV 感染女性在标准治疗后出现 CIN 持续存在或复发的风险较高 (6-14)。在可以进行 LEEP 治疗的地区，世界卫生组织建议使用 LEEP 治疗而不是冷冻治疗。该建议适用于女性，无论艾滋病毒感染状况如何。然而，很少有研究评估冷冻疗法或 LEEP 的疗效以及中低收入国家 HIV 感染女性成功治疗结果的相关因素。此外，针对中低收入国家艾滋病毒感染妇女的治疗尚未达成共识。 该应用的核心目标是增加我们对癌前病变不同治疗方式疗效的了解，这有助于为最佳治疗算法的实施提供信息，特别是针对中低收入国家中患有宫颈肿瘤的 HIV 感染女性。