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【文献翻译】CIN治疗后的浸润性宫颈癌

背景

1

本研究是一项历史回顾研究,比较了30例经宫颈锥切治疗后仍发生进展的宫颈癌(占1999-2016年间289例宫颈癌的10%)和164例同年度等效的治疗后CIN3的情况。

A historical audit of 30 post-treatment cervical cancers (10% of 289 cancers, 1999-2016) compared with a one-year-equivalent control group treated for cervical intraepithelial neoplasia (CIN) grade 3 (n = 164).

方法

2

对比癌症组和对照组的病史和随访记录,回顾初次锥切提示癌前病变的标本,以及对照组中占比41%的17例高级别病变复发和51例随访结果为持续阴性的病例。

We compared history and follow up of cancer patients and controls and reviewed initial excision biopsies preceding cancer and, in 41% of controls, high-grade recurrence (n = 17) or consistently negative follow-up (n = 51).

结果

3

27例鳞状细胞癌(SCC)患者中,19例(占比70%)术后细胞学检测异常未行高危人乳头状瘤病毒(hrHPV)检测,或者行二次锥切。所有30例癌症患者组,25例(占比83%)有细胞学、阴道镜检查、二次锥切、宫腔镜、hrHPV、和/或治疗延迟等方面的阴性随访结果。初次锥切与癌症诊断的平均时间间隔为79.8±30.1个月,而CIN3复发的平均间隔时间为11.2±30.1个月。癌症患者组中,有8例、13例和9例癌症患者分别在20-34岁、35-49岁和50岁以上时进行了初次切除,而对照组中对应年龄段的比例分别为71%、23%和5%。CIN3比CIN2更容易进展为SCC,比例约为22:1。30例行初次锥切术的患者中,有5例存在严重的异常核变性,但最初报告结果为阴性。病变完整切除后无SCC或CIN3复发。82例CIN3中,有20例浸润深度超过2mm,并且其中的18例(占比90%)存在癌症/高级别病变复发或早期间质浸润。复阅病理结果发现,10%的活检病理和34例细胞学切片中的9例存在异常结果。

Either abnormal post-excision cytology without high-risk human papillomavirus (hrHPV) tests or immediate re-excision was recorded in 70% (19 of 27) of patients with squamous cell carcinoma (SCC). Negative investigations including cytology, colposcopy, re-excision, hysteroscopy, hrHPV, and/or treatment default were recorded in 83% (25 of 30) of all cancers. The mean interval between initial excision and cancer diagnosis was 79.8 ± 30.1 months versus 11.2 ± 30.1 months for CIN3 recurrence. Eight, 13, and 9 patients with cancer had initial excision at age 20-34, 35-49, and 50+ years, respectively, compared with 71%, 23%, and 5% of controls. CIN3 more often preceded SCC than CIN2 (22:1); 5 of 30 initial excisions were originally reported as negative after severe dyskaryosis. No SCC or CIN3 recurrence followed complete excision. Depth of CIN3 2+ mm (20 of 82 reviewed) was strongly associated with cancer/high-grade recurrence or early stromal invasion on review (18 of 20; 90%). Discrepancies were found on review in 10% of biopsies and as occasional abnormal cells in 9 of 34 cytology slides.

结论

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在细胞学、阴道镜检查和/或组织学检查中,残余病变可能不明显或不存在。结合复发风险(年龄,CIN3深度,初始切除不完全)的术后管理可以避免疾病进展为癌症。

Residual disease may be inconspicuous or absent on cytology, colposcopy, and/or histology. Management taking account of risk of recurrence (age, CIN3 depth, incomplete initial excision) could avoid some post-treatment cancers.

参考文献

Amanda Herbert, Giuseppe Culora, Emma McLean, Ali A. Kubba, Invasive cervical cancer after treatment of CIN, J Am Soc Cytopathol. 2019 Aug 16. pii: S2213-2945(19)30104-8.

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撰稿 | 张蕊

编辑 | 陈丹

封面图片 | 赵大志

责任编辑 | 刘雨奇

审稿 | 江路 樊碧娆

审核 | 陶霞

声明:该文观点仅代表作者本人,搜狐号系信息发布平台,搜狐仅提供信息存储空间服务。

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