年龄对高级别宫颈病变患病率及管理的影响：一项回顾性队列研究

Introduction: Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer and can lead to high-grade cervical lesions (CIN2/3) requiring treatment and long-term surveillance. Current guidelines recommend at least 25 years of follow-up, including early post-treatment testing and screening every three years. However, age-related differences in adherence to these guidelines remain unclear. This study evaluates the impact of age on surveillance adherence and its implications for recurrence risk. Methods: This retrospective cohort study used U.S.- based TriNetX electronic health record data to evaluate age-related differences in adherence to post-treatment surveillance among women with high-grade cervical lesions. Women aged ≥21 years with histologically confirmed CIN2, CIN3, or high-grade squamous intraepithelial lesions were identified using ICD-9 and ICD-10 codes and stratified into decade-based age groups. Adherence to immediate treatment and short- and long-term surveillance was assessed as binary outcomes and compared across age groups using chi-square testing. Results of Data Characterization: Among all women with abnormal cytology results (641,172 patients), high-grade squamous intraepithelial lesions (HSIL) account for 5.32% (34,155 patients). Notably, HSIL prevalence was highest among younger patients. Among with abnormal cytology, 35% of women aged 21-29 years 30-39 years had HSIL, while prevalence of HSIL was lower in older age groups(15.36% in ages 40-49, 12.11% in ages 50-59, and 5.32% in ages ≥65). Within HSIL lesions, CIN2 and CIN3 were nearly equally represented (50.32% vs 49.68%), and the prevalence by age group showed a similar pattern for both lesions as with HSIL overall. Similarly to HSIL, CIN2 lesions were the most frequent in younger populations: 21-30 years (36.76%) and 31-40 years (36.14%). Cases with moderate numbers persist as age declines: 41-50 years (15.25%), 51-60 years (10.62%), and ≥65 years (1.22%). CIN3 lesions follow a similar distribution as CIN2 lesions across age groups: 21-30 years (33.85%), 31-40 years (36.57%), 41-50 years (17.10%), 51-60 years (10.50%), and ≥65 years (1.99%). Treatment Results: Within 2 years of diagnosis, 103,538 patients were followed. The majority of patients had no treatment (85.33%) whilst a small proportion of patients underwent a loop electrosurgical excision procedure (LEEP) (13.55%) and underwent ablative procedures (1.15%). Conclusions: In this large cohort of women with abnormal cytology, while HSIL represents a smaller proportion of abnormal pap smears, the majority of these lesions are disproportionately concentrated in women who are 40 years old and younger. CIN2 and CIN3 lesions are nearly equally distributed and follow a similar trend by age. Most people did not receive procedural treatment within 2 years of diagnosis. By the time of poster presentation, further analysis will be conducted to determine whether guideline concordance differs significantly across age groups.