Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/6245
Title: Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis
Risco de persistência da lesão intraepitelial escamosa de alto grau após tratamento excisional eletrocirúrgico com margens comprometidas: uma metanálise
Authors: Oliveira, Caroline Alves de
Russomano, Fábio Bastos
Gomes Junior, Saint Clair
Corrêa, Flávia de Miranda
Affilliation: Hospital Federal de Bonsucesso. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Educação. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Neonatologia, Rio de Janeiro, RJ, Brasil
Instituto Nacional do Câncer. Divisão de Apoio à Rede de Atenção Oncológica. Rio de Janeiro, RJ, Brasil
Abstract: CONTEXTO E OBJETIVO: As lesões precursoras do câncer de colo uterino, mesmo se tratadas adequadamente, têm risco de persistirem ou recidivarem. O objetivo foi quantificar o risco de persistência da lesão intraepitelial escamosa de alto grau (HSIL) em um e dois anos após tratamento excisional eletrocirúrgico do colo uterino com margens comprometidas. TIPO DE ESTUDO E LOCAL: Revisão sistemática da literatura e metanálise no Instituto Fernandes Figueira. METÓDO: Metanálise de estudos publicados entre janeiro de 1989 e julho de 2009 identificados em Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, Isis Web of Science e Sigle. Os artigos eram selecionados se fossem estudos tipo coorte sobre tratamento excisional eletrocirúrgico de HSIL com acompanhamento mínimo de um ano e tivessem como desfecho histopatológico a persistência de HSIL com pequeno risco de viés. RESULTADOS: Foram identificados 7.066 artigos e mais 21 nas listas de referências desses artigos. Após aplicação de critérios de seleção e de exclusão, somente quatro artigos ofereciam dados passíveis de extração. O risco de persistência da HSIL em um ano foi 11.36 vezes maior nas pacientes com margens comprometidas (intervalo de confiança, IC 95%: 5.529-23.379; P < 0,0001) e, em dois anos, chegou a quatro vezes, embora sem significância estatística (IC 95% 0.996-16.164). CONCLUSÃO: Esta metanálise confirma a importância de margem comprometida como indicador de tratamento incompleto no primeiro ano e ressalta a necessidade de uma adequada escolha da técnica eletrocirúrgica em função da localização e extensão da doença e um acompanhamento adequado dessas pacientes.
Abstract: CONTEXT AND OBJECTIVE: Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. DESIGN AND SETTING: Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. METHODS: This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. RESULTS: The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001) in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164), although without statistical significance. CONCLUSION: This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients.
Keywords: Cervical Intraepithelial Neoplasia.
Recurrence
Electrosurgery
Meta-analysis
keywords: Neoplasia Intra-Epitelial Cervical
Recidiva
Prognóstico
Eletrocirurgia
Metanálise
DeCS: Neoplasia Intra-Epitelial Cervical
Prognóstico
Eletrocirurgia
Metanálise
Recidiva
Issue Date: 2012
Publisher: Associação Paulista de Medicina
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Citation: OLIVEIRA, Caroline Alves de et al. Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis. Sao Paulo Med J., São Paulo, v. 130, n. 2, p. 119-125, 2012.
DOI: 10.1590/S1516-31802012000200009
Copyright: open access
Appears in Collections:IFF - Artigos de Periódicos

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