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重度宫颈上皮内瘤变进行环状电切手术治疗后病灶残余和 复发的高危因素

  • 摘要: 目的 探讨预测重度宫颈上皮内瘤变(CIN2及CIN3)进行环状电切手术(LEEP)治疗后残余病灶和疾病复发的高危因素,以及术后及早发现病变的时间点。方法 回顾性分析我院进行LEEP治疗的CIN2及CIN3共428例患者资料,治疗后用脱落细胞学和人乳头瘤病毒(HPV)杂交捕获二代(HC2)随访,以阴道镜活检为金标准判定残余和复发,据此评定其余指标的诊断价值。以logistic回归分析危险因素,κ检验验证3月和6月指标的一致性。结果 428例患者中CIN2有296例,CIN3有132例,治疗前HPV HC2 阳性率为86.7%(371/428), 随访中26例(6.1%)有残余或者复发, LEEP切缘受累特别是锥顶阳性是疾病持续或复发的高危因素〔比值比=9.364,95%可信区间(\CI):0.712~46.108,\P=0.001〕。其他因素如年龄(截断值40岁)、HPV负荷量(截断值100 RLU)、HPV类型(16/18 vs.其他类型)均与疾病复发无关。有残余病灶或复发的26例患者术后3月HPV HC2检测均为阳性, HPV HC2在术后3和6个月对于残余病灶的检测敏感性均为100%,均高于细胞学检测(\P\P\CI, 0.469~0.892)〕和细胞学检测结果〔κ值为0.79 (95%\CI: 0.592~0.873)〕都显示出较好的一致性。结论 LEEP手术后切缘受累特别是锥顶阳性是病灶残余或复发的危险因素。术后3月HPV检测可提供关于病灶残余或复发的及时信息。

     

    Abstract: Objective To explore the risk factors for residual/recurrent disease of cervical intraepithelial neoplasia (CIN) 2 or worse after loop electrosurgical excision procedure (LEEP) and the timing point for postoperative follow-up. Methods 428 patients with CIN 2 or CIN 3 who were treated with LEEP were retrospectively reviewed. Postoperative follow-up was performed by Pap smear and human papillomavirus (HPV) hybrid capture 2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse. Results 296 patients were CIN 2 and 132 were CIN 3 among 428 patients. The positive rate of HPV HC2 before LEEP was 86.7%(371/428). During follow-up, 26 patients (6.1%) had residual/recurrent disease, the positive LEEP margin, especially the cone top status, was a significant risk factor for persistent/recurrent disease. Other factors such as age, HPV viral load 〔≥100 relative light units (RLU)〕, and HPV typing (type 16/18 vs. other types) did not predict recurrence. HPV HC2 test at 3 months after LEEP can find all the residual/recurrent disease, the sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months. Conclusion The positive margin of LEEP specimen especially the cone top status was a significant risk factor for residual/recurrent disease after LEEP. HPV test at 3 months during follow-up can offer timely information about residual/recurrent disease and help for the risk control in treatment selection.

     

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