- 著者
-
沖 明典
Akinori OKI
筑波大学大学院人間総合科学研究科婦人周産期医学
Department of Obstetrics and Gynecology Graduate School of Comprehensive Human Sciences University of Tsukuba
- 雑誌
- 日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
- 巻号頁・発行日
- vol.58, no.11, pp.1739-1744, 2006-11-01
- 被引用文献数
-
3
[Purpose] Our aim is to clarify how HPV type and other prognostic factors are involved in regression and progression of CIN 1/2. The primary endpoint is progression to CIN 3 and the secondary endpoint is regression to normal cervix. The second aim is to make a guideline of management of CIN 1/2 based on the data from the cohort study. [Methods] The study subjects consisted of 570 women aged 54 or younger with cytologically and histologically confirmed CIN 1/2. CIN cases included 479 CIN 1 and 91 CIN 2. They were followed up at 4 month-interval and received cervical cytology and colposcopy at each visit. The study methods included a self-administered questionnaire, detection and typing of HPV, detection of serum antibody against HSV, CMV and Chlamydia trachomatis, and analysis of HLA class II alleles. A self-administered questionnaire were composed of 10 study variables including smoking, marital status, number of births, use of contraceptives and lifetime number of sexual partners. We used the HPV risk categories based on the meta-analysis of 14 Japanese reports; high-risk (HPV16/18/31/33/35/52/58), intermediate-risk (HPV39/45/51/56/59/68) and low-risk (other types of HPV) groups. [Results] The median follow-up time was 38.1 months. The 570 subjects were divided into 361 (63.3%) patients with regression, 172 (28.6%) patients with persistence and 46 (8.1%) patients with progression. The median regression time was 6.5 months and the median progression time was 17.9 months, suggesting that regression is an early event and progression is a late event in the national history of CIN 1/2. We used hazard ratio after adjustment of Age, CIN grade and HPV category to evaluate various prognostic factors, because the three factors were closely associated with both regression and progression in the univariate analysis. Age, CIN grade, HPV risk category, smoking, marital status, and number of sexual partners were significantly associated with CIN persistence, whereas CIN grade, HPV risk category and HLA class II allele (HLA DRB1*1302) had significant association with CIN progression. Based on these data, we proposed 'The Prognostic Scoring System for CIN 1/2' using three prognostic factors such as age (thirties; 1, others; 0), CIN grade (grade 2; 3, grade 1; 1, no histological confirmation; 0) and HPV risk category (high 3, intermediate; 1, low; 0). When the CIN 1/2 patient has 5 or higher points in this scoring system, the treatment of CIN 1/2 (LEEP, lasar vaporizaion or conization) is recommended. According to the decision rule, we need to treat most of CIN 2 patients and a part of CIN 1 patients. To compare with the ACOG guideline, this system can more accurately identify higher-risk group as target for treatment. [Conclusion] These data suggest that HPV type and CIN grade are the highest determinants of both regression and progression of CIN and host environmental factors (age, smoking, marital status, and number of sexual partners) may correlate with CIN regression and host genetic variations (HLA class II allele) may be associated with CIN progression. The new prognostic scoring system based on the data from the cohort study can be a new guideline for management of CIN 1/2.