IS CONSERVATIVE MANAGEMENT IN YOUNG WOMEN WITH CIN 2 SAFE?
BACKGROUND
Introduction: Cervical cancer is an important problem public health and can be prevented by screening. It is known that the treatment of precursor lesions is an important medical resource to prevent the progression to cervical cancer. In young women, there is not consensus on the management of precursor lesions, especially cervical intraepithelial neoplasia grade 2 (CIN 2), due to the high regression rates and rarity of invasive carcinomas in this group, in addition to the possibility of unfavorable obstetric outcomes, as a result of excisional treatment. The conservative management was recently recommended as a therapeutic approach in these cases. Methods: Retrospective longitudinal observational study which analysis patients with CIN 2 up to 30 years old at “Woman´s Hospital Prof. Dr. José Aristodemo Pinotti” in Campinas, São Paulo, submitted to conservative management, between 2012 and 2017. Data were obtained through the medical resgistry of selected patients. The regression, persistance and progression rates, besides the regression probabulity curve (RPC) were evaluated. For descriptive statistical analysis of numerical variables, mean values, standard deviation, proportions and Mann-Whitney test were used. In the comparison of categorical variables, the tests used were the Chi-square or Fischer's Exact tests. For the analysis of the regression curves and their comparisons, Kaplan-Meler and long-rank method were used. The study of factors associated with regression was performed using Cox regression analysis, simple and multiple. The level of significance used for the analyzes was 5%. Results: 65 patients were in agreement with the inclusion criteria. As to numerical variables, the mean age at diagnosis was 22.38 (SD: 4.22), while the mean age of onset sexual activity was 15,7 years (SD: 1.97). The average follow-up time for these patients was 17.98 months (SD: 9.84). Concerning the categorical variables, 66.15% of women were nulliparous, the smoking rate found was 14.06% and the use of hormonal contraceptives 61,5%. Considering the first 12 months of the follow-up, we could observe that 37 patients (56,9%) had two consecutive exams to support the regression, 20 (30,7%) had persistent lesions and in 8 patients (12,3% ) there was progression. The final outcome is regression in 73.3% in women <25 years, while in patients ? 25 years old, the regression rate found was 50,0%. In young women until 30 years, the probabilities of regression of CIN 2, according the RPC was: 42,0% at 6 months, 63.6%, at 12 months, 76.1% at 24 months and 84,1% at 36 months. No categorical variable was associated with RPC (P > 0,05). Conclusion: We conclude that young patients, especially under 25 years, have significant CIN 2 regression rates, supporting the effectiveness of conservative management for these group.
Keywords: Cervical Neoplasia, Cervical Intraepithelial Neoplasia, Human Papillomavirus.
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