BACKGROUND Although local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population. MATERIALS AND METHODS Design: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. DATA SYNTHESIS Summary effects were estimated using random-effects models. OUTCOMES Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population. RESULTS Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22-69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57-4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58-21.10; P < 0.001), vulvar (3.34, 2.39-4.67; P < 0.001), and anal cancer (5.11, 2.73-9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69-36.94; P = 0.073). CONCLUSIONS Women treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.

中文翻译：

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宫颈上皮内瘤变治疗后宫颈癌和其他恶性肿瘤的发病率和死亡率：文献的系统评价和荟萃分析。

背景 虽然宫颈上皮内瘤变 (CIN) 的局部治疗非常有效，但据报道，接受治疗的女性患宫颈癌和其他癌症的风险仍然增加。我们的目的是探讨 CIN 治疗后发生或死于宫颈癌和其他人乳头瘤病毒 (HPV) 和非 HPV 相关恶性肿瘤的风险，并与一般人群相比推断其程度。材料和方法 设计：系统评价和荟萃分析。资格标准：基于注册的随访报告 CIN 治疗后癌症发病率或死亡率的研究。数据综合 使用随机效应模型估计总结效应。结果 接受 CIN 治疗的女性宫颈癌发病率（每 10 万女性年）。宫颈癌的相对风险（RR），其他 HPV 相关的肛门生殖道癌（阴道、外阴、肛门）、任何癌症和死亡率，对于接受 CIN 治疗的女性与普通人群。结果 27 项研究符合条件。CIN 治疗后宫颈癌的发病率为 39/10 万女性年（95% 置信区间 22-69）。与普通人群相比，宫颈癌的RR升高（3.30，2.57-4.24；P < 0.001）。50 岁以上女性的 RR 较高，并且在治疗后至少 20 年保持较高水平。阴道癌（10.84, 5.58-21.10; P < 0.001）、外阴癌（3.34, 2.39-4.67; P < 0.001）和肛门癌（5.11, 2.73-9.55; P < 0.001）的RR也较高。宫颈癌/阴道癌的死亡率升高，但我们的估计更不确定（RR 5.04，0.69-36.94；P = 0.073）。结论 与一般人群相比，接受 CIN 治疗的女性后来被诊断为宫颈癌和其他 HPV 相关癌症的风险要高得多。宫颈癌的较高风险在治疗后持续至少 20 年，并且对于 50 岁以上的女性来说更高。对于先前接受过治疗的女性，可能需要在最后一轮筛查之后进行长期随访。