Background/Objectives:To evaluate the effectiveness of expectant management on grades 1 and 2 cervical intraepithelial neoplasia (CIN), including factors associated with regression and progression.Methods:This multicenter study included 561 women managed expectantly and 359 who underwent immediate surgery at eight institutes between 2013 and 2023.Results:Over a 4-year period, 63% and 68% of CIN 1 and CIN 2 cases regressed, and 9% and 14% of cases progressed, respectively. The median regression times were 1.5 years for CIN 1 and 1.2 years for CIN 2. High-risk human papillomavirus (HPV) types, especially HPV 58 (adjusted hazard ratio [HR]: 0.61;p= 0.032) and high-grade initial cytology, atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and high-grade squamous intraepithelial lesion (HSIL) (adjusted HR: 0.3,p< 0.001), were associated with a lower likelihood of regression. Also, hematological disorders reduced the likelihood of regression (adjusted HR 0.39,p= 0.045). In a separate analysis of the immediate surgery group, age in the 30s (p= 0.016) and HPV 16 infection (p= 0.005) were associated with pathologic upgrading at surgery.Conclusions:CIN 1 and 2 usually regress, allowing expectant management for up to 1.5 and 1.2 years, respectively. However, HPV 58 infection or high-grade initial cytology, and hematological disorders are indications for careful monitoring. Patients in their 30s or infected with HPV 16 have a higher risk of pathologic upgrading at surgery.
背景/目的：评估期待疗法对宫颈上皮内瘤变（CIN）1级和2级的有效性，包括与病变消退和进展相关的因素。 方法：这项多中心研究纳入了2013年至2023年间在八家机构接受期待治疗的561名女性以及接受即刻手术的359名女性。 结果：在4年观察期内，CIN 1和CIN 2的消退率分别为63%和68%，进展率分别为9%和14%。CIN 1和CIN 2的中位消退时间分别为1.5年和1.2年。高危型人乳头瘤病毒（HPV）感染，尤其是HPV 58型（调整后风险比[HR]：0.61；p=0.032），以及高级别初始细胞学结果，包括非典型鳞状细胞-不排除高级别鳞状上皮内病变（ASC-H）和高级别鳞状上皮内病变（HSIL）（调整后HR：0.3，p<0.001），与较低的消退可能性相关。此外，血液系统疾病也会降低消退的可能性（调整后HR：0.39，p=0.045）。在对即刻手术组的单独分析中，30-39岁年龄组（p=0.016）和HPV 16感染（p=0.005）与手术时病理升级相关。 结论：CIN 1和CIN 2通常可以消退，因此可分别采用最长1.5年和1.2年的期待治疗。然而，HPV 58感染、高级别初始细胞学结果以及血液系统疾病是需要密切监测的指征。30-39岁患者或HPV 16感染者手术时病理升级的风险更高。
肿瘤(癌症)患者之家