Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08,p= 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p= 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p= 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings.
目的：本研究旨在评估接受保守治疗的宫颈原位/微浸润腺癌（AC）患者的长期随访结果。方法：开展一项回顾性多中心研究，纳入接受保留生育功能治疗的早期宫颈腺体病变患者，并进行为期5年的随访。评估与复发相关的独立变量，采用逻辑回归分析及Logrank检验的Kaplan-Meier生存分析。结果：在269例确诊为原位/微浸润腺癌的女性中，127例接受了保守治疗。随访期间，9例患者（7.1%）出现复发。随访期间唯一与复发相关的因素是高风险人乳头瘤病毒（hr-HPV）检测阳性（比值比6.21，置信区间1.47–26.08，p=0.012）。HPV阳性患者的复发率为21.7%，而HPV阴性患者为3.8%（p=0.002，Logrank检验）。在随访期间hr-HPV检测阴性的患者中，非普通型组织学患者的复发率为20.0%，而普通型患者为2.1%（p=0.005）。结论：鉴于其复发预测价值，随访期间的HPV检测对接受保守治疗的早期宫颈腺体病变患者至关重要。然而，随访期间hr-HPV检测阴性但组织病理学为非普通型的患者可能构成复发风险增加的亚群。需进一步研究验证这些发现。
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