宫颈癌治疗后高危型人乳头瘤病毒转阴与预后关系研究  

Research on the relationship between the regression of HR-HPV and prognosis in the patients with cervicalcancer after treatment

作　　者：宋丹[1] 孔为民[1] 张同庆[1] 焦思萌[1] 陈娇[1] 商若天 刘瑶[1] 李霞[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,北京100006

出　　处：《中国实用妇科与产科杂志》2017年第9期975-978,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市科委生物医药与生命科学创新培育研究项目(Z151100003915149)

摘　　要：目的探讨宫颈癌患者治疗后高危型人乳头瘤病毒(HR-HPV)转阴情况与宫颈癌预后的关系。方法回顾性分析2011年1月至2012年12月在首都医科大学附属北京妇产医院接受治疗的宫颈癌患者189例,随访截止至2015年12月。观察宫颈癌复发及患者生存情况,并对其与HR-HPV转阴的关系进行研究。结果 189例宫颈癌患者中鳞癌173例,腺癌16例;接受治疗后,存活3年以上患者161例,3年内死亡28例;HR-HPV转阴152例,持续阳性37例;复发患者39例,其中盆腔复发22例,远处转移17例。宫颈癌治疗后HR-HPV是否转阴对宫颈癌复发及3年生存率均有明显统计学意义(P<0.05)。HR-HPV是否转阴对盆腔复发有统计学意义(P<0.05),而对远处转移无统计学意义(P>0.05)。HR-HPV和细胞学检查对宫颈癌复发的灵敏度分别为72.97%和57.50%,差异有统计学意义(P=0.017);特异度分别为92.11%和89.26%,差异无统计学意义(P=0.318)。结论宫颈癌治疗后HR-HPV持续阳性增加复发及死亡危险;HR-HPV持续阳性增加局部复发的危险,但并不增加远处转移的危险;HR-HPV阴性也不能杜绝局部复发与远处转移;HR-HPV监测复发灵敏度及特异度均高于细胞学检查。宫颈癌治疗后进行HR-HPV监测可能是必要的。Objective To investigate the association between the regression of HR-HPV and the prognosis in patients with cervical cancer after treatment. Methods A retrospective analysis of 189 cases of cervical cancer after treatment in Beijing Obstetrics and Gynecology Hospital from January 2011 to December 2012 was involved in this trial. The follow-up period was ended in December 2012. Investigate the relationship of the recurrence and survival situation with HR-HPV infection.Results A total of 189 cases received treatment,including 173 cases of squamous carcinoma and16 cases of adenocarcinoma,161 cases survived over 3 years and 28 patients died within 3 years;152 cases were tested negative for HR-HPV,while 37 cases had persistent positive HR-HPV;39 cases had recurrence,of whom 22 cases had pelvic recurrence and the others had distant metastasis. Whether HR-HPV had negative conversion or not had statistical significance in the recurrence and three-year survival rate（P〈0.05）. Whether HR-HPV turned negative or not had statistical significance in pelvic recurrence（P〈0.05）,but not in distant metastasis（P〉0.05）. HR-HPV was significantly more sensitive（72.97%）compared to follow-up cervicovaginal cytology（57.50%）（P=0.017）in the recurrence of cervical cencer. Moreover,the cytology had limited specificity（89.26%）compared to HR-HPV test（92.11%）（P=0.318）.Conclusion Persistent positive HR-HPV after the treatment for cervical cancer increases the risk of recurrence and death.It also increases the risk of local recurrence but does not appear to increase the risk of distant metastases. Negative HRHPV can not put an end to local recurrence and distant metastasis. HR-HPV test shows a higher sensitivity and specificity than cervicovaginal cytology.Thus it seems to be necessary to carry out HR-HPV monitoring after the treatment for cervical cancer.

关 键 词：宫颈肿瘤 高危型人乳头瘤病毒 预后 复发 转移 

分 类 号：R737.3[医药卫生—肿瘤]