文章：

大环状转化区切除术（LLETZ）后高危型人乳头瘤病毒（HR-HPV）阴性且切缘清晰者的长期安全性评估

Long-Term Reassurance with Negative High-Risk Human Papillomavirus (HR-HPV) and Clear Margins After Large Loop Excision of the Transformation Zone (LLETZ)

原文发布日期：1 February 2025

DOI: 10.3390/cancers17030487

类型: Article

开放获取: 是

英文摘要：

Background/Objective: Women treated with large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2-3 (CIN2-3) remain at risk of CIN2-3 and cervical cancer for many years. We assessed the roles of high-risk human papillomavirus (HR-HPV) post-LLETZ, surgical margins, and LLETZ characteristics on the long-term risk of CIN2-3. Methods: A retrospective observational study was performed using data for 432 women with a histological diagnosis of CIN2-3 treated by LLETZ between 1996 and 2020 and followed-up until October 2021 at Hospital Bellvitge in Barcelona, Spain. Age, surgical margins, 6-month HR-HPV status, excision type, and cone volume/dimensions were analyzed in association with the risk of persistent/recurrent CIN2-3. The cumulative probability of persistent/recurrent CIN2-3 was calculated using the Kaplan–Meier and Cox models. Results: Persistent/recurrent CIN2-3 was detected in 7.4%, with over 90% found within 5 years post-LLETZ. Predictors of persistent/recurrent CIN2-3 were HR-HPV (HR = 7.36, 95% CI = 3.55–15.26), involved margins (HR = 3.94, 95% CI = 1.68–9.25), uncertain margins (HR = 4.42, 95% CI = 1.55–12.55), and age ≥ 35 years (HR = 2.92, 95% CI = 1.19–7.13). Type 3 excision (p= 0.035) and cone length (p= 0.010) correlated with clear margins. The negative predictive value (NPV) of both negative HR-HPV and clear margins post-LLETZ was 98.7%. Conclusions: The combination of negative HR-HPV and clear margins post-LLETZ provides stronger reassurance against the risk of persistent/recurrent CIN2-3 than do LLETZ characteristics. However, larger excisions in older women likely reduce the risk of involved margins. Close surveillance, including repeat HR-HPV testing in the first 5 years post-LLETZ, is crucial.

摘要翻译： 

背景/目的：接受宫颈转化区大环切除术（LLETZ）治疗的宫颈上皮内瘤变2-3级（CIN2-3）患者，在术后多年内仍面临CIN2-3及宫颈癌的风险。本研究评估了LLETZ术后高危型人乳头瘤病毒（HR-HPV）状态、手术切缘及LLETZ特征对CIN2-3长期复发风险的影响。方法：本研究为回顾性观察性研究，纳入1996年至2020年间在西班牙巴塞罗那贝尔维特医院经组织学诊断为CIN2-3并接受LLETZ治疗的432例女性患者，随访至2021年10月。分析年龄、手术切缘状态、术后6个月HR-HPV状态、切除类型及锥切体积/尺寸与CIN2-3持续/复发风险的关系。采用Kaplan-Meier法和Cox模型计算CIN2-3持续/复发的累积概率。结果：CIN2-3持续/复发率为7.4%，其中超过90%发生在LLETZ术后5年内。CIN2-3持续/复发的预测因素包括：HR-HPV阳性（HR=7.36，95% CI=3.55–15.26）、切缘阳性（HR=3.94，95% CI=1.68–9.25）、切缘不确定（HR=4.42，95% CI=1.55–12.55）以及年龄≥35岁（HR=2.92，95% CI=1.19–7.13）。3型切除（p=0.035）和锥切长度（p=0.010）与切缘阴性相关。LLETZ术后HR-HPV阴性且切缘阴性的阴性预测值（NPV）为98.7%。结论：与LLETZ手术特征相比，术后HR-HPV阴性联合切缘阴性对降低CIN2-3持续/复发风险具有更强的保障作用。然而，对高龄女性实施更大范围的切除可能降低切缘阳性的风险。密切随访（包括在LLETZ术后5年内重复HR-HPV检测）至关重要。

原文链接：

Long-Term Reassurance with Negative High-Risk Human Papillomavirus (HR-HPV) and Clear Margins After Large Loop Excision of the Transformation Zone (LLETZ)