抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ的临床观察

目的:探讨抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ的疗效。方法:选取2012年2月至2015年11月期间在我院门诊就诊患者,选取146例HPV高危感染合并宫颈CINⅠ患者,随机分为研究组和对照组,研究组84例,采用抗HPV生物蛋白敷料阴道上药,每次1支,隔日1次,10次为1个疗程,连用3个疗程。对照组62例,未使用药物,仅做观察。结果:在第4个月复查宫颈脱落细胞学检查和HPV检测,研究组总有效率为80.95%,对照组总有效率为46.67%,两组比较,差异有统计学意义(P0.05)。研究组宫颈脱落细胞学检查转阴率为80.77%,对照组转阴率为31.58%,两组比较,差异有统计学意义(P0.05)。结论:抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ可能有效,未发现不良反应。     

Classical and non-classical HLA molecules and p16(INK4a) expression in precursors lesions and invasive cervical cancer

Objectives

Viruses and tumour cells may regulate the expression of HLA molecules on the cell surface to escape immune system surveillance. Absence of classical HLA class I molecules may impair the action of specific cytotoxic cells, whereas non-classical HLA class I molecules may regulate innate and adaptive immune cells. We assess here the possible associations between classical/non-classical class I HLA and p16^INK4a molecule expression in cervical biopsies of women infected with HPV, stratified according to grade of the lesion and HPV type.

Study design

Cervical biopsies (N = 74) presenting cervical intraepithelial neoplasia grade 1 (CIN1) (n = 31), CIN2–3 (n = 19), and invasive cancer (n = 14) were evaluated alongside 10 normal cervical specimens.

Results

HLA-A/B/C/G staining was observed in the early stages of HPV infection. A significant association was detected between HLA-A/B/C staining and HPV16/18 infection (OR = 0.12, 95%CI: 0.0163–0.7899; p = 0.04). HLA-E expression increased with the progression of the lesion (χ²-test for trend = 4.01; p = 0.05), and a significant association was found between HLA-E staining and HPV16/18 infection (OR = 11.25, 95%CI: 2.324–54.465; p = 0.003). Irrespective of the grade of the lesion, HLA-A/B/C staining and p16^INK4a presented a good concordance (Kappa: 0.67).

Conclusions

HLA-E overexpression seemed to be associated with invasive cancer and HPV16/18 infection.     

Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years

Objective  To establish the effect of margin status on recurrence following large loop excision of the transformation zone (LLETZ) in women over 50 years.
Study design  Prospectively collected data of women over 50 years, who underwent LLETZ for suspected cervical intraepithelial neoplasia between 1998 and 2003, were analysed. Women were followed up for up to over 6 years.
Setting  District colposcopy service based at a gynae-oncology cancer centre.
Main outcome measures  The main outcome measure included histologically detected recurrence. Any abnormal cytology on follow up was also documented.
Methods  Prospectively collected data were analysed from the colposcopy database. Recurrence was analysed using Kaplan–Meir plots and Cox regression. Fisher's exact test was used to determine the association between margins and grade. The Kruskal–Wallis and Mann–Whitney U tests were used to compare age and duration of follow up between groups.
Results  A total of 118 women underwent LLETZ and 92 were included in the final analysis. Margins were designated as clear ( n = 62), involved ( n = 22) or uncertain ( n = 8). Histological recurrence occurred in 12 while abnormal cytology was demonstrated in 17 women. One woman with involved margins developed cervical cancer. Individuals with clear margins were less likely to have recurrence than those with involved margins (Hazard Ratio (HR) 0.18, 95% CI: 0.06–0.59). Involved margins were more common with high-grade than low-grade lesions ( P = 0.002).
Conclusion  The data show an association between disease recurrence and the finding of involved margins in this cohort.     

Treatment of high-grade squamous intraepithelial lesions: a "see and treat" versus a three-step approach

OBJECTIVE: The study's subject was to examine the correlation between histologic findings in patients with high-grade squamous intraepithelial lesion (HGSIL) who have undergone loop electrosurgical excisional procedure (LEEP) with and without prior colposcopically directed biopsy. STUDY DESIGN: This retrospective study included 144 patients with cytologic HGSIL, of which 62 were treated by a three-step protocol, in which LEEP was performed only if the colposcopically directed cervical biopsies were positive (CIN II-III), and 82 women who were treated by "see and treat" protocol, in which LEEP was immediately performed if colposcopy was suggestive of CIN II or III lesions. RESULTS: There were no differences in the final histological findings between the groups. CONCLUSIONS: The colposcopically directed LEEP after a HGSIL on PAP-smear may reduce the time interval between diagnosis and treatment with a similar accuracy of diagnosis compared to the standard three-step protocol.     

Management of multicentric lesions of the lower genital tract

OBJECTIVES: To report management and outcome of multicentric lesions of the lower genital tract. To define risk factors of recurrence. STUDY DESIGN: Retrospective review of multicentric dysplasias treated in our colposcopic clinic between 1996 and 2003. Multicentric dysplasias included CIN with VAIN and/or VIN. After primary treatment, follow-up was colposcopic, cytologic and virologic. RESULTS: Forty-four patients presented multicentric lesions out of 998 patients referred for CIN (4.4%). The average age was 36.8 years. Immunologic disorders were present in 20.4%. Ninety-one percent had cervicovaginal or cervicovulvar lesions, only 9% had three sites of genital dysplasia. 53.3% of lesions were concomitant. 79.5% of CIN were high grade, 62.5% of VAIN low grade and 62.5% of VIN high grade. Therapeutic modalities were as follows: conization for CIN (70.4%), CO2 laser for VAIN (33.3%) and surgery for VIN (41.7%). Forty patients were followed and had at least one post-treatment cytologic control; 55% of them had residual disease. Out of the 23 patients with at least two negative controls after treatment, 43.5% presented recurrence. Risk of recurrence was not statistically bound to such parameters as tabagism, immunologic disorder, high grade lesions, non-surgical treatment, and persistence of HPV infection after treatment. CONCLUSION: Multicentric dysplasias are associated with high rate of residual lesion and recurrence. Management of these lesions require long term follow-up.