伴有HR-HPV感染的HSIL患者宫颈锥切术后HR-HPV转归及其与病变复发的相关性研究
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摘要
目的分析伴有HR-HPV感染的HSIL宫颈锥切术后的转归情况,探讨HR-HPV转归与宫颈病变复发的关系。方法对2009年1月至2016年8月在首都医科大学附属北京妇产医院妇瘤科行宫颈锥切术的632例HR-HPV阳性的HSIL患者进行回顾性分析,于术后3、6、9、12、18、24个月进行HR-HPV以及病变复发情况随访。结果 632例HSIL患者术后6、9、12、18、24个月HR-HPV转阴率分别为28.2%、48.7%、53.1%、61.7%、72.1%;在术后6、9个月,感染HPV16/18型者转阴率显著低于非16/18型者(P <0.05);而在术后12、18、24个月HPV16/18型组转阴率虽仍低于非16/18型组,但差异无统计学意义(P> 0.05);在术后6、9、12、18、24个月,HR-HPV单一型感染者转阴率低于多重感染者,但两组差异均无统计学意义(P> 0.05)。632例患者随访中,有31例(4.9%,31/632)复发,HR-HPV转阴者复发率显著低于未转阴者(P <0.05)。结论术后HR-HPV随时间推移转阴率增加;术后12个月后HPV16/18型转阴率与非16/18型无差别;术后HR-HPV多重与单一感染转阴率无差别。术后18个月HR-HPV仍未转阴者病变复发风险较高。
Objective To analyse HR-HPV clearance of HSIL with HR-HPV infection after conization, and to explore the correlation between HR-HPV clearance and recurrence of cervical lesion. Methods A retrospective analysis of 632 patients with HSIL and HR-HPV infection receiving conization in Department of Gynecological Oncology, Beijing Obstetrics and Gynecological Hospital from Jan 2009 to Aug 2016 was performed. The patients were tested with HRHPV genotyping in 3, 6, 9, 12, 18, 24 months after conization, and the recurrence were also observed and recorded during follow-up. Results Among the 632 patients with HSIL, the HR-HPV clearance rates were 28.2%, 48.7%, 53.1%, 61.7%, 72.1% in 6, 9, 12, 18, 24 months after conization. In 6, 9 months after conization, the HR-HPV clearance rates of the patients with HR-HPV 16/18 infection showed signiícant differences compared with other genotypes(P < 0.05). While in 12, 18, 24 months after conization, no signiícant difference were detected(P > 0.05). In 6, 9, 12, 18, 24 months after conization, the HR-HPV clearance rates of the patients with single infection showed no signiícant difference compared with multiple infection(P > 0.05). Among the 632 patients, recurrences were found in 31 cases(4.9%, 31/632). The recurrence rates of the patients with HR-HPV clearance were signiícant lower when compared with those without HRHPV clearance(P < 0.05). Conclusions HR-HPV is cleared gradually after conization among the patients with HSIL. There is no distinction in HR-HPV clearance between the patients with HR-HPV 16/18 infection and other genotypes since 12 months after conization. Also there is no distinction between the patients with single infection and multiple infection. The patients without HR-HPV clearance within 18 months have a high risk of recurrence of cervical lesions.
Objective To analyse HR-HPV clearance of HSIL with HR-HPV infection after conization, and to explore the correlation between HR-HPV clearance and recurrence of cervical lesion. Methods A retrospective analysis of 632 patients with HSIL and HR-HPV infection receiving conization in Department of Gynecological Oncology, Beijing Obstetrics and Gynecological Hospital from Jan 2009 to Aug 2016 was performed. The patients were tested with HRHPV genotyping in 3, 6, 9, 12, 18, 24 months after conization, and the recurrence were also observed and recorded during follow-up. Results Among the 632 patients with HSIL, the HR-HPV clearance rates were 28.2%, 48.7%, 53.1%, 61.7%, 72.1% in 6, 9, 12, 18, 24 months after conization. In 6, 9 months after conization, the HR-HPV clearance rates of the patients with HR-HPV 16/18 infection showed signiícant differences compared with other genotypes(P < 0.05). While in 12, 18, 24 months after conization, no signiícant difference were detected(P > 0.05). In 6, 9, 12, 18, 24 months after conization, the HR-HPV clearance rates of the patients with single infection showed no signiícant difference compared with multiple infection(P > 0.05). Among the 632 patients, recurrences were found in 31 cases(4.9%, 31/632). The recurrence rates of the patients with HR-HPV clearance were signiícant lower when compared with those without HRHPV clearance(P < 0.05). Conclusions HR-HPV is cleared gradually after conization among the patients with HSIL. There is no distinction in HR-HPV clearance between the patients with HR-HPV 16/18 infection and other genotypes since 12 months after conization. Also there is no distinction between the patients with single infection and multiple infection. The patients without HR-HPV clearance within 18 months have a high risk of recurrence of cervical lesions.
引文
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[14]陶祥,郑宝文,赵澄泉.子宫颈细胞学和高危型人乳头瘤病毒感染多中心临床资料分析[J].中国妇产科临床杂志,2018,19(2):187-189.
[15]Schiffman M,Wentzensen N,Khan MJ,et al.Preparing for the Next Round of ASCCP-Sponsored Cervical Screening and Management Guidelines[J].J Low Genit Tract Dis,2017,21(2):87-90.
[2]Zhang G,Lang J,Shen K,et al.High-risk human papillomavirus infection clearance following conization among patients with cervical intraepithelial neoplasm grade 3 aged at least 45years[J].Int J of Gynaecol&Obstet,2017,136(1):47-52.
[3]王雁,孔为民,吴玉梅,等.宫颈冷刀锥切术和全子宫切除术对CINⅢ合并高危型HPV阳性患者治疗结局的影响[J].实用妇产科杂志,2016,32(2):122-125.
[4]Mesher D,Panwar K,Thomas SL,et al.Continuing reductions in HPV 16/18 in a population with high coverage of bivalent HPVvaccination in England:an ongoing cross-sectional study[J].BMJ Open,2016,6(2):e009915.
[5]Moore EE,Danielewski JA,Garland SM,et al.Clearance of human papillomavirus in women treated for cervical dysplasia[J].Obstet&Gynecol,2011,117(1):101-108.
[6]Kudoh A,Sato S,Itamochi H,et al.Human papillomavirus typespeciíc persistence and reappearance after successful conization in patients with cervical intraepithelial neoplasia[J].Int Journal Clin Oncol,2016,21(3):580-587.
[7]Soto DE León SC,Del RL,Camargo M,et al.Persistence,clearance and reinfection regarding six high risk human papillomavirus types in Colombian women:a follow-up study[J].BMCInfect Dis,2014,14(1):395-407.
[8]Gosvig CF,Huusom LD,Deltour I,et al.Role of human papillomavirus testing and cytology in follow-up after conization[J].Acta Obset Gynecol Scand,2015,94(4):405-411.
[9]Huh WK,Ault KA,Chelmow D,et al.Use of Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening:Interim Clinical Guidance[J].Gynecol Oncol,2015,136(2):178-182.
[10]Khan MJ,Werner CL,Darragh TM,et al.ASCCP Colposcopy Standards:Role of Colposcopy,Beneíts,Potential Harms,and Terminology for Colposcopic Practice[J].J Low Genit Tract Dis,2017,21(4):223.
[11]Wentzensen N,Schiffman M,Silver MI,et al.ASCCP Colposcopy Standards:Risk-Based Colposcopy Practice[J].J Low Genit Tract Dis,2017,21(4):230.
[12]Koh WJ,Aburustum NR,Bean S,et al.Uterine Neoplasms,Version 1.2018,NCCN Clinical Practice Guidelines in Oncology[J].Journal of the National Comprehensive Cancer Network Jnccn,2018,16(2):170-199.
[13]魏丽惠,赵昀,沈丹华,等.中国子宫颈癌筛查及异常管理相关问题专家共识(一)[J].中国妇产科临床杂志,2017,18(2):190-192.
[14]陶祥,郑宝文,赵澄泉.子宫颈细胞学和高危型人乳头瘤病毒感染多中心临床资料分析[J].中国妇产科临床杂志,2018,19(2):187-189.
[15]Schiffman M,Wentzensen N,Khan MJ,et al.Preparing for the Next Round of ASCCP-Sponsored Cervical Screening and Management Guidelines[J].J Low Genit Tract Dis,2017,21(2):87-90.