宫颈癌术后人乳头瘤病毒的转归及其临床意义
发布时间：2019-03-08 18:39
【摘要】：目的:人乳头瘤病毒(human papillomavirus,HPV)的持续感染已被证实是宫颈癌(cervical cancer)的主要病因。手术是早期宫颈癌(FIGO分期I-IIA)的主要治疗方法,既可以达到切除病灶的目的,对人乳头瘤病毒的清除也有一定的作用。然而手术不可能完全清除HPV,术后HPV转阴受相关因素的影响,HPV的持续感染可进一步导致某些病变的发生,如阴道上皮内瘤变(vaginal intraepithelial neoplasia,VAIN)等。本文章通过了解宫颈癌术后HPV转归的一般情况,分析影响HPV清除的相关因素,探讨HPV转归对宫颈癌术后复发、继发阴道病变的预测作用,指导临床随访。方法:1.纳入2012年1月至2013年12月在青岛大学附属医院妇科确诊并接受手术治疗的宫颈癌患者375例。2.术后临床随访3年,第1年每3个月随访1次,HPV转阴后延长为每6个月随访1次,第2~3年每6个月随访1次。随访内容包括妇科查体、HPV检测(第二代杂交捕获实验室技术,HC-II)、液基细胞学检查(TCT)、血清肿瘤标记物检测及影像学检查。3.记录HPV清除时间,分析患者年龄、宫颈癌分期、肿瘤分化程度、手术方式(包括筋膜外全子宫切除术与广泛子宫切除术、开腹手术与腹腔镜手术、术中是否保留卵巢)以及术后是否辅助治疗等因素对HPV清除的影响;通过了解HPV转归,探讨术后HPV检测对宫颈癌复发及继发阴道病变的预测意义。4.HPV清除时间的分析采用生存函数Kaplan-Meier法,组间HPV清除时间的比较采用Log-rank检验,影响HPV清除的相关因素采用COX比例风险模型进行多因素分析,P0.05代表差异具有统计学意义。结果:1.375例宫颈癌患者术后HPV清除的中位时间是7个月(95%CI为6.41~7.59个月),HPV在1年之内转阴者272例(78.39%,272/347),第1~2年内转阴者46例(13.26%,46/347),第2~3年内转阴者13例(3.75%,13/347)。2.将研究因素行单因素分析,结果显示患者年龄(P0.05)、宫颈癌分期(P0.05)、子宫切除范围(筋膜外全子宫切除或广泛子宫切除)(P0.05)是影响宫颈癌术后HPV清除的相关因素,进一步行多因素分析,结果显示患者年龄是HPV清除的独立危险因素(P0.05)。3.宫颈癌术后HPV检测预测宫颈癌复发的特异度为80.3%,灵敏度为88.2%,预测阴道病变的特异度为86.8%,灵敏度为93.0%。结论:1.宫颈癌术后HPV清除的中位时间为7个月,清除率随着时间的延长逐渐增高,大多数于术后2年内清除。2.患者年龄、宫颈癌分期、子宫切除范围是术后HPV清除的影响因素,其中患者年龄是HPV清除的独立影响因素,年龄越大,HPV清除所需时间越长。3.宫颈癌术后HPV持续感染与宫颈癌复发及阴道病变有关,术后HPV检测对预测宫颈癌复发及继发阴道病变有较高的敏感性和特异性。
[Abstract]:Objective: persistent infection of human papillomavirus (human papillomavirus,HPV) has been proved to be the main cause of (cervical cancer) in cervical cancer. Surgery is the main treatment for early cervical cancer (FIGO stage I-IIA), which can not only remove the lesion, but also have a certain effect on the clearance of human papillomavirus (HPV). However, it is not possible to completely remove the negative conversion of HPV after HPV, due to related factors. The persistent infection of HPV may further lead to some pathological changes, such as vaginal intraepithelial neoplasia (vaginal intraepithelial neoplasia,VAIN) and so on. The purpose of this paper is to investigate the general situation of HPV outcome after cervical cancer and to analyze the related factors affecting HPV clearance, and to explore the predictive effect of HPV prognosis on recurrence and secondary vaginal lesion of cervical cancer after operation, so as to guide clinical follow-up. Methods: 1. From January 2012 to December 2013, 375 cervical cancer patients were admitted to Qingdao University affiliated Hospital for Gynecologic diagnosis and Surgical treatment. The clinical follow-up was 3 years after operation, once every 3 months in the first year. After HPV turned negative, it was prolonged to be followed up every 6 months, and once every 6 months in the second to third year. The follow-up included gynecological examination, HPV test (second generation hybridization capture laboratory technique, HC-II), liquid-based cytology examination, detection of serum tumor markers and imaging examination of (TCT),. 3. Record the duration of HPV clearance, analyze the age of the patient, stage of cervical cancer, degree of tumor differentiation, and surgical methods (including total fascia hysterectomy and extensive hysterectomy, open surgery and laparoscopic surgery). The influence of ovarian preservation during operation and adjuvant therapy after operation on the clearance of HPV; By understanding the prognosis of HPV, the significance of postoperative HPV detection in predicting the recurrence of cervical cancer and secondary vaginal lesions was discussed. 4. The survival function Kaplan-Meier method was used to analyze the clearance time of HPV, and the Log-rank test was used to compare the time of HPV clearance between groups. The factors related to HPV clearance were analyzed by COX proportional hazard model, and the difference was statistically significant (P0.05). Results: the median time of removal of HPV in 1.375 patients with cervical cancer was 7 months (95%CI = 6.41 to 7.59 months). Within one year,), HPV turned negative in 272 cases (78.39%, 272%), and in 46 cases (13.26%) within 1-2 years. 46 / 347), 13 cases (3.75%, 13 / 347) turned negative within 2 ~ 3 years. Univariate analysis showed that the age of the patients (P0.05) and the stage of cervical cancer (P0.05). The scope of hysterectomy (extrafascial total hysterectomy or extensive hysterectomy) (P0.05) was the related factor affecting the removal of HPV after cervical cancer, and further multivariate analysis was performed. The results showed that age was an independent risk factor for HPV clearance (P0.05). The specificity, sensitivity and sensitivity of HPV were 80.3%, 88.2%, 86.8%, 93.0%, 86.8%, 88.2% and 93.0%, respectively. Conclusions: 1. The median time of removal of HPV after cervical cancer was 7 months, and the clearance rate increased gradually with the prolongation of time, most of which were removed within 2 years after operation. The age of the patient, the stage of cervical cancer and the scope of hysterectomy were the influencing factors of HPV clearance after operation, and the age of the patient was the independent influencing factor of HPV clearance. The older the patient was, the longer it took to remove HPV. The persistent infection of HPV after cervical cancer is related to the recurrence of cervical cancer and vaginal lesion. The detection of HPV after operation has a high sensitivity and specificity for predicting the recurrence of cervical cancer and secondary vaginal lesion.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2437095
[Abstract]:Objective: persistent infection of human papillomavirus (human papillomavirus,HPV) has been proved to be the main cause of (cervical cancer) in cervical cancer. Surgery is the main treatment for early cervical cancer (FIGO stage I-IIA), which can not only remove the lesion, but also have a certain effect on the clearance of human papillomavirus (HPV). However, it is not possible to completely remove the negative conversion of HPV after HPV, due to related factors. The persistent infection of HPV may further lead to some pathological changes, such as vaginal intraepithelial neoplasia (vaginal intraepithelial neoplasia,VAIN) and so on. The purpose of this paper is to investigate the general situation of HPV outcome after cervical cancer and to analyze the related factors affecting HPV clearance, and to explore the predictive effect of HPV prognosis on recurrence and secondary vaginal lesion of cervical cancer after operation, so as to guide clinical follow-up. Methods: 1. From January 2012 to December 2013, 375 cervical cancer patients were admitted to Qingdao University affiliated Hospital for Gynecologic diagnosis and Surgical treatment. The clinical follow-up was 3 years after operation, once every 3 months in the first year. After HPV turned negative, it was prolonged to be followed up every 6 months, and once every 6 months in the second to third year. The follow-up included gynecological examination, HPV test (second generation hybridization capture laboratory technique, HC-II), liquid-based cytology examination, detection of serum tumor markers and imaging examination of (TCT),. 3. Record the duration of HPV clearance, analyze the age of the patient, stage of cervical cancer, degree of tumor differentiation, and surgical methods (including total fascia hysterectomy and extensive hysterectomy, open surgery and laparoscopic surgery). The influence of ovarian preservation during operation and adjuvant therapy after operation on the clearance of HPV; By understanding the prognosis of HPV, the significance of postoperative HPV detection in predicting the recurrence of cervical cancer and secondary vaginal lesions was discussed. 4. The survival function Kaplan-Meier method was used to analyze the clearance time of HPV, and the Log-rank test was used to compare the time of HPV clearance between groups. The factors related to HPV clearance were analyzed by COX proportional hazard model, and the difference was statistically significant (P0.05). Results: the median time of removal of HPV in 1.375 patients with cervical cancer was 7 months (95%CI = 6.41 to 7.59 months). Within one year,), HPV turned negative in 272 cases (78.39%, 272%), and in 46 cases (13.26%) within 1-2 years. 46 / 347), 13 cases (3.75%, 13 / 347) turned negative within 2 ~ 3 years. Univariate analysis showed that the age of the patients (P0.05) and the stage of cervical cancer (P0.05). The scope of hysterectomy (extrafascial total hysterectomy or extensive hysterectomy) (P0.05) was the related factor affecting the removal of HPV after cervical cancer, and further multivariate analysis was performed. The results showed that age was an independent risk factor for HPV clearance (P0.05). The specificity, sensitivity and sensitivity of HPV were 80.3%, 88.2%, 86.8%, 93.0%, 86.8%, 88.2% and 93.0%, respectively. Conclusions: 1. The median time of removal of HPV after cervical cancer was 7 months, and the clearance rate increased gradually with the prolongation of time, most of which were removed within 2 years after operation. The age of the patient, the stage of cervical cancer and the scope of hysterectomy were the influencing factors of HPV clearance after operation, and the age of the patient was the independent influencing factor of HPV clearance. The older the patient was, the longer it took to remove HPV. The persistent infection of HPV after cervical cancer is related to the recurrence of cervical cancer and vaginal lesion. The detection of HPV after operation has a high sensitivity and specificity for predicting the recurrence of cervical cancer and secondary vaginal lesion.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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