医学
宫颈上皮内瘤变
阴道镜检查
危险系数
优势比
置信区间
比例危险模型
回顾性队列研究
妇科
内科学
逻辑回归
人口
产科
宫颈癌
癌症
环境卫生
作者
María E. Fernández-Montolí,Sara Tous,Gabriela Medina,Marc Castellarnau,Amparo Garcia-Tejedor,S de Sanjosé
标识
DOI:10.1111/1471-0528.15996
摘要
Objective To assess the long-term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2–3) and time to recurrence after large loop excision of the transformation zone (LLETZ). Design Retrospective study. Setting Colposcopy clinic. Population 242 women with CIN 2–3 treated between 1996 and 2006 and followed up until June 2016. Methods Age, margins, and high-risk human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan–Meier analysis. Main outcome measure Histologically confirmed CIN 2–3, HR-HPV, margins, age. Results CIN 2–3 was associated with HR-HPV (HR = 30.5, 95% confidence interval [CI] = 3.80–246.20), age >35 years (HR = 5.53, 95% CI = 1.22–25.13), and margins (HR = 7.31, 95% CI = 1.60–33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto+/endocervical+ (16.7%), uncertain (19.4%) and ecto−/endocervical+ margins (9.1%) showed a higher risk of recurrence (odds ratio [OR] = 13.20, 95% CI = 1.02–170.96; OR = 15.84, 95% CI = 3.02–83.01; and OR = 6.60, 95% CI = 0.88–49.53, respectively). Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001). Conclusions HR-HPV and margins seem essential for stratifying post-LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women to reduce the risk. Tweetable abstract After LLETZ for CIN 2–3, recurrences appear more often in women with positive HR-HPV and involved margins and aged over 35.
科研通智能强力驱动
Strongly Powered by AbleSci AI