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J Clin Oncol:大多数2-3级宫颈上皮内瘤变(CIN2/3)不需要治疗

2022-05-12 Nebula MedSci原创

宫颈筛查可通过检测和治疗 2 级或 3 级宫颈上皮内瘤变 (CIN2/3) 来预防宫颈癌。但是,筛查也会导致过度医疗,因为部分 CIN 2/3 病变在不治疗的情况下也可自发消退。

宫颈筛查可通过检测和治疗 2 级或 3 级宫颈上皮内瘤变 (CIN2/3) 来预防宫颈癌。但是,筛查也会导致过度医疗,因为部分 CIN 2/3 病变在不治疗的情况下也可自发消退。

本研究是一项多中心的纵向队列研究,目的是在未治疗的 CIN 2/3 女性中评估FAM19A4/miR124-2 甲基化对 CIN2/3 临床转归的预测意义。

研究人员对患有 CIN2/3 的女性进行了 24 个月的前瞻性随访。用观察代替手术切除。通过基线时收集的样本检测 FAM19A4/miR124-2 甲基化。每 6 个月进行一次人乳头瘤病毒 (HPV) 检测和细胞学检查,并进行阴道镜检查以排除 CIN 进展。最后一次随访时,进行两次活检。临床消退定义:经组织学证实不存在 CIN2+ 或 HPV 阴性且细胞学正常。


根据基线FAM19A4/miR124-2 甲基化分层的临床消退率

共招募了 114 位女性(中位年龄 30岁,范围20-53岁),其中 80 位被确诊为CNI2,34 位为 CIN3。在研究期间,65.8%的女性(75/114)未接受手术治疗FAM19A4/miR124-2 甲基化阴性的女性比 FAM19A4/miR124-2 甲基化阳性的女性表现出更高的临床消退率(74.7% vs 51.3%,p=0.013)。


不同亚组分析的临床消退率

当细胞学检查为意义不明的非典型鳞状细胞/低级别鳞状上皮内病变 (88.4%) 或 HPV16 阴性 (85.1%) 时,FAM19A4/miR124-2 甲基化阴性的女性的消退率最高。

综上,大多数基线 FAM19A4/miR124-2 甲基化阴性的未经治疗的 CIN2/3 可自发临床消退。FAM19A4/miR124-2 甲基化检测与细胞学或 HPV 基因分型相结合,可用于指导 CIN2/3 女性患者选择手术治疗还是随访观察。

 

原始出处:

Wieke W. Kremer, et al. Clinical Regression of High-Grade Cervical Intraepithelial Neoplasia Is Associated With Absence of FAM19A4/miR124-2 DNA Methylation (CONCERVE Study). Journal of Clinical Oncology. https://creativecommons.org/licenses/by-nc-nd/4.0/

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    2022-12-09 鲜嫩如花的小春 来自江西省

    甲基化

    0

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    2022-11-11 kalseyzl
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    2022-06-13 minlingfeng
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    2022-05-13 一闲

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