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https://www.arca.fiocruz.br/handle/icict/24476
LESÕES PRECURSORAS DO CÂNCER CERVICAL: POSITIVIDADE PARA O PAPILOMAVÍRUS HUMANO E FALHA DO TRATAMENTO EM UMA COORTE HOSPITALAR DE MULHERES TRATADAS NUM CENTRO DE REFERÊNCIA DO RIO DE JANEIRO, BRASIL
Papillomavirus infections / diagnosis
Cervical Intra-Epithelial Neoplasia / diagnosis
Cervical Intra-Epithelial Neoplasia / mortality
Infecções por Papillomavirus/diagnóstico
Neoplasia Intra-Epitelial Cervical/diagnóstico
Neoplasia Intra-Epitelial Cervical/mortalidade
Dantas, Vanessa Wallerstein Mignone | Date Issued:
2013
Alternative title
Precursor lesions of cervical cancer: human papillomavirus positivity and treatment failure in a hospital cohort of women treated at a referral center in Rio de Janeiro, BrazilAffilliation
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Abstract in Portuguese
O Papilomavírus Humano (HPV) é o principal fator de risco associado ao desenvolvimento e evolução das lesões precursoras do câncer cervical, mas para que uma célula normal evolua para uma célula neoplásica é necessária a ação de cofatores como idade, tabagismo e uso de contraceptivos orais. A evolução natural do câncer cervical passa por uma fase precursora chamada de Neoplasia Intraepitelial Cervical (NIC), cuja exérese é o tratamento indicado para impedir a evolução. No entanto, o acompanhamento das pacientes é fundamental para que seja possível diagnosticar e tratar possíveis falhas de tratamento durante o seguimento. Embora o principal fator associado à falha de tratamento seja a infecção pelo HPV após o tratamento, outros possíveis cofatores podem estar atuando, porém ainda não há um consenso na literatura.Objetivo: Avaliar os fatores associados à positividade para HPV de alto risco (HRHPV) e à falha de tratamento, em mulheres submetidas à exérese de lesões precursoras,num centro de referência do Rio de Janeiro. Métodos: Foi realizado um estudo exploratório de uma coorte hospitalar de 290 mulheres tratadas para NIC, composto de um estudo transversal em dois momentos (seis meses e dois anos após o tratamento),para avaliar a presença de infecção por HPV, e um estudo prospectivo para estimar o risco de falha de tratamento durante dois anos de seguimento. (...). Conclusão: O presente estudo sugere que a presença da infecção por HR-HPV seis meses após o tratamento e positividade para HPV aos três e seis meses podem aumentar significativamente o risco para falha de tratamento.
Abstract
Human Papillomavirus is the main risk factor for CIN development and progression, nevertheless only HPV infection is not a sufficient cause for development of disease. Other co-factors such as age, smoking and oral contraceptive use have to be associated with HPV infection for CIN progression. The natural evolution for cervical cancer passes through a pre-neoplasic phase call Cervical Intraepithelial Neoplasia (CIN). Even patients that are correctly treated should be followed after treatment of CIN to diagnose and treat possible treatment failures during follow-up. Although the main factor associated with cervical cancer and treatment failure is HPV, another possible cofactors could be involved, however this is not well established in literature. Objectives: The present study has the goal to investigate the frequency of HR-HPV positivity and the risk of treatment failure during a two-year follow-up period of women treated in a reference center in Rio de Janeiro, Brazil. Methods: Within a hospital cohort of 290 women treated for CIN a cross-sectional study was performed at two points during follow-up to analyze HPV infection at 6 month and 2 years after treatment. Besides that, a prospective study was performed to identify the risk of treatment failure in 2 years. Results: HR-HPV infection was present in 24,7% e 18,2% of treated women, six months and two years after treatment, respectively. The time between menarche and first sexual intercourse > 3 years was associated with a lower risk of having a HPV infection 6 month after treatment (Odds Ratio = 0,48; IC 95% = 0,23 - 0,99). The main factor associated with HR-HPV infection 2 years after treatment was HR-HPV infection 6 month after treatment (OR = 4,27; CI 95% = 1,54 – 11,82). The global risk of treatment failure in a two year follow-up was 3,0%.Women HR-HPV positive between 3 and 6 months had a 8,5% risk of treatment failure (log rank = 0,006) and women who had at least one positive test between 3 and 6 months had a HR=12,25 (CI 95% = 1,55 – 96,91). The risk of treatment failure for HR-HPV infected women at 6 months after treatment was 17,0% (LR 95% = 0,001). Patients that had endocervical margin involvement presented an increased relative risk of a 3,37 (CI 95% = 0,95 – 11,99) of treatment failure. Conclusions: The present study suggests that HR-HPV presence after treatment and the presence of HPV 3 and 6 months after treatment could raise significantly the risk of treatment failure.
Keywords
Precancerous LesionsPapillomavirus infections / diagnosis
Cervical Intra-Epithelial Neoplasia / diagnosis
Cervical Intra-Epithelial Neoplasia / mortality
DeCS
Lesões Pré-CancerosasInfecções por Papillomavirus/diagnóstico
Neoplasia Intra-Epitelial Cervical/diagnóstico
Neoplasia Intra-Epitelial Cervical/mortalidade
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