Value of high-risk HPV persistent infection in follow-up of expectant treatment for CIN Ⅱ in patients aged ≤40 years: a prospective cohort study
10.3760/cma.j.cn112141-20240923-00517
- VernacularTitle:高危型HPV持续感染在年龄≤40岁CINⅡ患者期待治疗随访中的意义基于前瞻性队列研究
- Author:
Huanhua WANG
1
;
Yueyun WANG
;
Yanqing KONG
;
Ping JIN
Author Information
1. 南方医科大学深圳妇幼保健院妇科，深圳 518055
- Publication Type:Journal Article
- Keywords:
Cervical intraepithelial neoplasia;
Squamous intraepithelial lesions of the cervix;
Papillomavirus infection;
Watchful waiting;
Follow-up studies
- From:
Chinese Journal of Obstetrics and Gynecology
2024;59(12):925-932
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the value of high-risk human papillomavirus (HR-HPV) persistent infection in the follow-up of expectant treatment for cervical intraepithelial neoplasia (CIN) Ⅱ in patients aged ≤40 years.Methods:A prospective cohort study was conducted. Women aged ≤40 years with fertility needs, cervical transformation zone type Ⅰ-Ⅱ, and CIN Ⅱ pathology under colposcopy-guided biopsy were selected from the cervical outpatient clinic of Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University. HR-HPV genotyping test, cytological examination, and colposcopy evaluation were used for regular follow-up for 2 years. The natural outcomes of the lesions were obesrved, and the predictive value of HR-HPV persistent infection in the persistence or progression of CIN Ⅱ lesions was analyzed.Results:A total of 135 eligible patients were collected, and completed the follow-up for (26±11) months. Of them, 88 patients (65.2%, 88/135) showed regression, 27 (20.0%, 27/135) persistence to CIN Ⅱ, and 20 (14.8%, 20/135) progression to CIN Ⅲ (no one cervical cancer). Among 135 patients with CIN Ⅱ, there were 68 cases (50.4%, 68/135) of HR-HPV persistent infection and 67 cases (49.6%, 67/135) of HR-HPV non-persistent infection, respectively. The persistence or progression rate of CINⅡ lesions in patients with HR-HPV persistent infection was significantly higher than that in patients with HR-HPV non-persistent infection [66.2% (45/68) vs 3.0% (2/67); χ2=59.38, P<0.001]. HR-HPV persistent infection was an independent risk factor for persistence or progression of CIN Ⅱlesions ( OR=30.93, 95% CI: 5.63-169.74, P<0.001); with predictive sensitivity and specificity of 95.7% (45/47) and 73.9% (65/88), respectively, the sensitivity and specificity of predicting the progression of CIN Ⅱ lesions were 100.0% (20/20) and 58.3% (67/115), respectively. Within the first year of follow-up, 86.4% (76/88) of CIN Ⅱ patients showed lesion regression, and 83.6% (56/67) of CIN Ⅱ patients experienced HR-HPV conversion to negative. The persistence or progression rate of CIN Ⅱ lesions in 42 patients with HPV 16 and (or) 18 (HPV 16/18) infection (47.6%, 20/42) at the time of enrollment was significantly higher than that in 93 patients with other HR-HPV (not HPV 16/18) infection (29.0%, 27/93; χ2=4.40, P=0.036); the progression rate of CIN Ⅱ in patients with HPV 16/18 persistent infection (44.4%, 12/27) was significantly higher than that in patients with other HR-HPV (not HPV 16/18) persistent infection (19.5%, 8/41; χ2=4.87, P=0.027). Conclusions:HR-HPV persistent infection is a sensitive indicator to predict persistence or progression of CIN Ⅱ lesions in patients aged ≤40 years, which could be used as the basis for risk stratification management of expectant treatment of CIN Ⅱ. For CIN Ⅱ lesion regression and HR-HPV negative conversion usually occur within the first year, the follow-up time could be shortened to 1 year to reduce the risk of disease progression; surgical treatment is recommended for patients with HR-HPV persistent infection, especially HPV 16/18 infection.
