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必看:2016年宫颈癌临床指南及重大研究进展

2016-12-22 MedSci MedSci原创

据最新2015中国癌症统计报告显示,在女性特有的肿瘤中,乳腺癌位居第一,宫颈癌第二,是最常见的妇科恶性肿瘤,且发病年龄日益年轻化。2015年国内宫颈癌新发病例估计9.89万例,死亡人数有3.05万例,城市高于农村,考虑到缺乏筛查和治疗的人群,实际发病人数应高于统计数据。下面小编为大家盘点2016宫颈癌临床指南及重大研究进展,供大家学习参考,希望对大家有所帮助。【1】Br J Cancer:宫颈

据最新2015中国癌症统计报告显示,在女性特有的肿瘤中,乳腺癌位居第一,宫颈癌第二,是最常见的妇科恶性肿瘤,且发病年龄日益年轻化。2015年国内宫颈癌新发病例估计9.89万例,死亡人数有3.05万例,城市高于农村,考虑到缺乏筛查和治疗的人群,实际发病人数应高于统计数据。下面小编为大家盘点2016宫颈癌临床指南及重大研究进展,供大家学习参考,希望对大家有所帮助。

【1】Br J Cancer:宫颈癌筛查对宫颈癌死亡率有什么影响?

毫无疑问,对宫颈癌筛查可以预防宫颈癌,但是定期筛查对宫颈癌死亡率的影响又怎样?目前仍是未知的。

基于人群的病例对照研究,采用了英国1988-2013年的前瞻性宫颈筛查数据。2007年4月至2013年3月,共有11619名妇女诊断为宫颈癌,年龄25-79岁。对每一例宫颈癌患者按年龄匹配两例非癌症对照组。使用条件逻辑回归估计阶段特定癌症的比值比(OR)(前15年时间里定期筛查 vs 不筛查;不定期筛查 vs 不筛查)。

数据显示,35-64岁女性的定期宫颈癌筛查,可以降低67%的1A期宫颈癌发生率(95% CI 62-73%),以及降低95%的3期或更严重的宫颈癌发生率(95% CI: 94-97%)。定期进行宫颈癌筛查(≤5.5年)的女性与没有进行宫颈癌筛查的女性相比,癌症发生率的OR值为0.18 (95% CI: 0.16-0.19),死亡率的OR值为0.08 (95% CI: 0.07-0.09)。

据估计,英国目前宫颈癌筛查可以预防70% (95% CI: 66-73%)的宫颈癌死亡;如果每个人都定期进行宫颈癌筛查,那么这一数据将会变为83% (95% CI: 82-84%)。

宫颈癌筛查和高级别宫颈癌发病率之间的关联是十分强烈的,宫颈癌筛查可有效预防死亡!(文章详见--Br J Cancer:宫颈癌筛查对宫颈癌死亡率有什么影响?

【2】p16/Ki-67双染检测助力宫颈癌前病变诊断

2012年,美国病理学家协会(CAP)和美国阴道镜和宫颈病理学会(ASCCP)联合发布了下生殖道HPV相关的鳞状病变的命名标准化计划(LAST)指南,最终认定p16是有足够的临床研究数据证实其可用于宫颈癌前病变诊断的生物标志物。2015年11月26日,国家食品药品监督管理局批准罗氏诊断CINtec PLUS细胞学试剂盒[抗p16(E6H4)/Ki-67(274- 11 AC3)单克隆抗体鸡尾酒试剂(免疫细胞化学法)]用于宫颈脱落细胞学的诊断。

2015年Besthesda指南推荐免疫细胞化学可辅助细胞学诊断。指南指出,在检出HSIL病变中,p16/Ki-67双染与细胞学检测的特异性相当,且具有高敏感性。

研究证实CINtec PLUS双染检测灵敏度与特异性高

美国本土最大型的前瞻性宫颈癌筛查临床试验ATHENA研究,入组47208名受试者,进行了基于cobas HPV初筛策略和以细胞学为基础筛查策略的三年随访试验。结果显示,针对HPV16/18以外的12种高危型HPV阳性患者,比较巴氏涂片细胞学与CINtec PLUS检测评估三年内进展为CIN3+风险时发现:CINtec PLUS检测能够得到简单、客观的结果,明确提示患者风险以及是否需转诊阴道镜。CINtec PLUS阳性患者在3年内进展为CIN3+病变的风险远高于细胞学ASCUS以上的患者,具有更好的阳性预测值,需要转诊阴道镜以减少漏诊。CINtec PLUS阴性的患者,3年内发生CIN3+病变的风险低于细胞学NILM的患者,具有更好的阴性预测值,不需要转诊阴道镜,帮助减少过度治疗。

前瞻性PALMS研究入组来自5个欧洲国家的27349个病例。大量临床数据显示,CINtec PLUS双染检测具有高灵敏度与高特异性,可用于ASC-US分流、LSIL分流,HPV初筛后对高危型HPV阳性者分流,对细胞学阴性但高危型HPV阳性患者进行分流。

该研究2015年发表在《癌症细胞病理学》的最新数据显示:对于细胞学ASC-US患者的分流中,CINtec PLUS检测和HC2 HPV检测的阴道镜转诊率分别为26%与42%;对于细胞学LSIL患者的分流中,阴道镜转诊率分别为53%与84%。证实使用CINtec PLUS检测能够显著降低阴道镜转诊率,减少不必要的阴道镜转诊,避免过度诊断,同时能够帮助临床医生对患者进行精准分层管理,进而实现早期干预。(文章详见——p16/Ki-67双染检测助力宫颈癌前病变诊断

【3】EULAR 2016:红斑狼疮会增加宫颈癌风险

来自瑞典卡罗林斯卡学院医学部的一项研究表明,系统性红斑狼疮(SLE)会增加宫颈癌风险,尤其是使用免疫抑制药物治疗的患者。

该研究对4450名SLE女性进行了研究,匹配了28113名对照组。其中使用抗疟药的有1783人,其他免疫抑制治疗的有1981人。

结果显示,与对照组相比,SLE女性宫颈非典型增生或浸润性宫颈癌风险增倍。使用全身免疫抑制药物的患者与抗疟药治疗的患者相比,癌症风险更高;并且宫颈不典型增生或肿瘤的风险更高。(文章详见——EULAR 2016:红斑狼疮会增加宫颈癌风险

【4】缺乏运动更容易患宫颈癌

据发表于Journal of Lower Genital Tract Disease的一项新研究显示,久坐的女性更容易患上宫颈癌,而每周只需要做30分钟的运动即可显著地降低该风险。

该研究涉及了128名被诊断为宫颈癌的女性和512名曾被怀疑患有宫颈癌最后又被否定的女性。在这些被诊断出宫颈癌的女性中,31%的人缺乏运动。缺乏运动在此次的研究中被定义为每个月的运动量少于4次。

研究结果显示,即使在研究人员考虑了其他危险因素,诸如吸烟,嗜酒,有宫颈癌家族史和体重指数后,这些缺乏运动的女性患宫颈癌的风险几率依旧是有运动的女性的2.5倍。此外,研究人员还发现,那些被怀疑患有宫颈癌的女性中,有26%的人缺乏运动。(文章详见—— 缺乏运动更容易患宫颈癌!

【5】NEJM:皮肤幼虫移行症-案例报道

RA和SLE可增加1.5倍宫颈重度不典型增生和宫颈癌的发生风险

既往有研究提示系统性炎症性疾病(SID)[如炎症性肠病(IBD)和系统性红斑狼疮(SLE)]患者存在宫颈癌的潜在风险。那么SID女性患者发生宫颈重度不典型增生(宫颈癌的一个替代终点)和宫颈癌的风险到底有多高呢?

研究人员利用2001~2012年美国的健康保险数据,进行了一项队列研究,共纳入了133333例SID女性患者及533332例无SID的女性。结果在平均2.1年随访中,SID女性患者中宫颈重度不典型增生和宫颈癌的粗发病率在SLE患者中最高,在银屑病中最低,而无SID女性粗发病率为73.4/10万人年。校正混杂因素后,其多变量风险比在IBD中为1.07,在银屑病中为0.96,在RA中为1.49,在SLE中为1.53。在基线时已使用系统性免疫抑制剂或类固醇治疗的IBD、RA和SLE患者,其多变量风险比有所增加但不具有统计学意义。(文章详见——系统性炎症性疾病女性患者宫颈癌的潜在风险有多高?

【6】2016 NCCN临床实践指南:宫颈癌(Version1.2016)

2016年7月,美国国家综合癌症网络(NCCN)发布了宫颈癌指南2016年第2版,指南更新摘要如下:
临床分期(CERV-1)

IA1期(无淋巴血管间隙浸润),IA1期(有淋巴血管间隙浸润)以及IA2期,IB1期(保留生殖能力)(CERV-2)

IA1期(无淋巴血管间隙浸润),IA1期(有淋巴血管间隙浸润)以及IA2期(不保留生殖能力)(CERV-3)

IB1期和IIA1期(不保留生殖能力)(CERV-4)

IB2期和IIA2期(不保留生殖能力)(CERV-4)

IB2期、IIA2期以及IIB、IIIA、IIIB、IVA期(CERV-6)

子宫切除偶然发现侵袭性肿瘤(CERV-9)

治疗监测(CERV-10)

局限性肿瘤复发(CERV-11)

远处转移(CERV-12)

实验室检查与外科手术分期的原则(CERV-A)

宫颈癌放疗原则(CERV-B)

Sedlis标准:淋巴结、肿瘤边缘以及子宫旁组织阴性患者子宫广泛切除术后行外放射治疗(CERV-C)

复发和转移性宫颈癌的化疗方案(CERV-D)

分期(ST-1)(文章详见——2016 NCCN临床实践指南:宫颈癌(Version1.2016)

【7】2016 HKCOG指南:宫颈癌的预防和筛查

2016年11月,香港妇产科学院(HKCOG)发布了宫颈癌的预防和筛查指南。异常宫颈涂片管理指南最后更新于2008年,该指南主要包括的新的信息有:HPV疫苗作为宫颈癌初级预防的指导;应用HPV检测作为初级筛查指导,WHO2014命名,2014分级系统以及不同人乳头状瘤病毒检测的细节。(文章详见--2016 HKCOG指南:宫颈癌的预防和筛查)

【8】2017 NCCN临床实践指南:宫颈癌(2017.V1)

2016年10月,美国国家综合癌症网络(NCCN)发布了宫颈癌指南2017年第1版。(文章详见--2017 NCCN临床实践指南:宫颈癌(2017.V1)

【9】2016ACOG实践简报:宫颈癌的筛查和预防-临时更新(No.168)发布

2016年10月,美国妇产科医师学会(ACOG)临床更新发布了宫颈癌的筛查和预防指南。以替代2016年1月发布的第157指南,该指南主要聚焦HIV或免疫功能不全的青少年和年轻女性宫颈癌的筛查。(文章详见--2016ACOG实践简报:宫颈癌的筛查和预防-临时更新(No.168)发布

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    2017-04-07 克勤

    学习了

    0

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    2016-12-25 yingy02042

    谢谢?

    0

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    2016-12-24 一闲
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    2016-12-22 虈亣靌

    己阅,谢谢分享

    0

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