Project 2

项目2

基本信息

批准号：
8935185
负责人：
DARRON R BROWN
金额：
$ 16.5万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-19 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8935185
关键词：
AIDS/HIV problem Acetic Acids Adopted Algorithms Biopsy Carcinoma Cells Cervical Cervical Cancer Screening Cervical Intraepithelial Neoplasia Cervix Neoplasms Cessation of life Coagulation Process Cold Therapy Colposcopy Conization Consensus Country Development Diagnosis Educational process of instructing Excision Failure Frequencies HIV HIV Infections Health Services Accessibility Histologic Histology Hospital Referrals Human Papillomavirus Hysterectomy Income Institutes Kenya Knowledge Laser vaporization Lesion Life Loop electrosurgical excision procedure Malignant Neoplasms Malignant neoplasm of cervix uteri Methods Modality Modeling Oncogenic Pap smear Patients Population Premalignant Prevalence Recommendation Recurrence Research Resources Risk Risk Factors Testing Translating Treatment Failure Treatment outcome Visit Visual Woman base cervical cancer prevention clinical care cohort cost experience follow-up high risk oncology prevent programs screening standard of care

项目摘要

Project 2 In 2008,' cervical cancer was responsible for 275,000 deaths, of which about 88% occurred in low- and middle-income countries (LMIC) (1,2). Cervical cancer is the third most common cancer in women worldwide and the most common cancer in many LMIC. In most cases, there is a slow progression from atypical cells to cervical intraepithelial neoplasia (CIN) to invasive carcinoma. Precancerous lesions can be treated and invasive cervical cancer be prevented. The screening methods currently available include cytological smears (Pap smear), visual inspection with acetic acid (VIA), and human papillomavirus (HPV) testing. A diagnosis of CIN can be confirmed by histology (biopsy), with or without colposcopy. There are also many treatment methods that are available, including cryotherapy, LEEP/ large loop excision of the transformation zone(LLETZ), cold knife conization (CKC), laser vaporization, cold coagulation, and hysterectomy. Many resource-limited countries have adopted a "single visit" or "screen-and-treat" approach using cryotherapy following a positive screening test. Cryotherapy has become the initial mode of treatment because of its feasibility and the limited availability of colposcopy/biopsy/LEEP. HIV has been shown to increase the risk of the development, progression and recurrence of CIN (3-5). Several studies have consistently shown that HIV-infected women present higher risk of CIN persistence or recurrence after standard therapy (6-14). In settings where LEEP is available and accessible, treatment with LEEP over cryotherapy is recommended by the WHO. This recommendation applies to women regardless of HIV status. However, there is a paucity of studies assessing the efficacy of cryotherapy or LEEP and the factors associated with successful treatment outcomes among HIV-infected women in LMIC. Moreover, there is no consensus in the treatment specifically for HIV-infected women in LMIC. The core objective of this application is to increase our knowledge about the efficacy of different treatment modalities for precancerous lesions which can help inform the implementation of the best treatment algorithms particularly for HIV-infected women with cervical neoplasia in LMIC.

项目2 2008年，宫颈癌造成275,000人死亡，其中约88％发生在低收入和中等收入国家（LMIC）（1,2）。宫颈癌是全球女性第三大常见的癌症，也是许多LMIC中最常见的癌症。在大多数情况下，从非典型细胞到宫颈上皮内肿瘤（CIN）到浸润性癌的进展缓慢。可以治疗癌前病变，并防止浸润性宫颈癌。当前可用的筛选方法包括细胞学涂片（PAP涂片），乙酸（VIA）和人乳头瘤病毒（HPV）测试的视觉检查。 CIN的诊断可以通过组织学（活检），有或没有阴道镜证实。还有许多可用的治疗方法，包括冷冻疗法，转化区（Lletz）的LEEP/大环切除，冷刀锥（CKC），激光汽化，冷凝结和子宫切除术。在积极的筛查测试后，许多资源有限的国家使用冷冻疗法采用了“一次访问”或“屏幕和治疗”方法。由于其可行性和阴道镜检查/活检/LEEP的可用性有限，冷冻疗法已成为最初的治疗方式。艾滋病毒已被证明会增加CIN发育，进展和复发的风险（3-5）。几项研究一直表明，艾滋病毒感染的妇女在标准治疗后表现出更高的CIN持久性或复发风险（6-14）。在可以使用并可以使用的情况下，WHO建议对LEEP进行冷冻疗法的治疗。无论艾滋病毒状况如何，该建议适用于妇女。但是，评估冷冻疗法或LEEP的功效以及与LMIC的HIV感染妇女成功治疗结果相关的因素很少。此外，在LMIC中，专门针对HIV感染的妇女没有达成共识。该应用的核心目的是提高我们对不同治疗方式对癌前病变的疗效的了解，这可以帮助告知最佳治疗算法的实施，尤其是对于LMIC中宫颈肿瘤的艾滋病毒感染的妇女。