背景:最近在许多国家/地区实施了对宫颈上皮内瘤变2级(CIN2)的主动监测,包括北欧国家。在丹麦,CIN2主动监测的唯一资格标准是该女性应为育龄期.通过这项研究,我们的目的是评估通过主动监测或大环圈切除转化区(LLETZ)治疗的CIN2女性的临床和社会经济特征,并评估CIN2临床治疗的时间变化.
方法:我们使用来自医疗保健注册的数据进行了一项丹麦全国范围的研究。所有18-40岁的女性居民,纳入了从1998年1月1日至2020年2月29日诊断为N2的事件。我们收集了年龄数据,索引细胞学结果,CIN2诊断年份,居住地区,公民身份,HPV疫苗接种状态,和社会经济地位指标。变量按总体和管理组列出(主动监测与LLETZ).为了评估时间趋势,我们使用连接点回归计算年度百分比变化(APC),包括95%置信区间(CI)。
结果:在27536名患有CIN2的女性中,12500人(45.4%)接受了主动监测,和15036(54.6%)接受了LLETZ。接受主动监测的女性更年轻,更经常接种HPV疫苗,与接受LLETZ的女性相比,更有可能获得正常/低度指数的细胞学结果。社会经济状况指标没有差异。随着时间的推移,接受主动监测的女性比例从2004年的21.7%上升至2019年的73.6%(APC9.7,95%CI8.1-11.4).30岁以下接受主动监测的女性比例随着时间的推移而下降(APC-2.2,95%CI-2.9至-1.5)。2019年正常/低度指数细胞学的女性比例略有上升至51.6%(APC0.8,95%CI0.4-1.3)。
结论:在过去的二十年中,丹麦对CIN2的主动监测的使用有所增加。观察到接受主动监测的女性与LLETZ之间的特征差异可能与临床治疗的适应症有关。
BACKGROUND: Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) has been implemented recently in many countries, including the Nordic countries. In Denmark, the only eligibility criterion for active surveillance for CIN2 is that the woman should be of reproductive age. With this study, we aimed to evaluate clinical and socioeconomic characteristics in women with CIN2 managed by active surveillance or large loop excision of the transformation zone (LLETZ) and to evaluate temporal changes in the clinical management of CIN2.
METHODS: We conducted a Danish nationwide study using data from healthcare registries. All female residents aged 18-40 years, diagnosed with incident CIN2 from January 1, 1998, to February 29, 2020, were included. We collected data on age, index cytology result, year of CIN2 diagnosis, region of residence, civil status, HPV vaccination status, and socioeconomic position indicators. The variables were tabulated overall and by management group (active surveillance vs. LLETZ). To evaluate time trends, we used joinpoint regression to calculate the annual percentage change (APC), including 95% confidence intervals (CI).
RESULTS: Of the 27 536 women with CIN2 included, 12 500 (45.4%) underwent active surveillance, and 15 036 (54.6%) underwent a LLETZ. Women undergoing active surveillance were younger, more often HPV-vaccinated, and more likely to have a normal/low-grade index cytology result than women undergoing LLETZ. Socioeconomic position indicators did not differ. Over time, the proportion of women undergoing active surveillance increased from 21.7% in 2004 to 73.6% in 2019 (APC 9.7, 95% CI 8.1-11.4). The proportion of women undergoing active surveillance aged <30 declined over time (APC -2.2, 95% CI -2.9 to -1.5). The proportion of women with normal/low-grade index cytology increased slightly to 51.6% in 2019 (APC 0.8, 95% CI 0.4-1.3).
CONCLUSIONS: The use of active surveillance for CIN2 has increased over the past two decades in Denmark. Observed differences in characteristics between women undergoing active surveillance vs LLETZ are likely related to indications for clinical management.