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首页> 外文期刊>Iranian Journal of Neurology >Evaluation of the risk of cervical cancer in patients with Multiple Sclerosis treated with cytotoxic agents: A cohort study
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Evaluation of the risk of cervical cancer in patients with Multiple Sclerosis treated with cytotoxic agents: A cohort study

机译：细胞毒性药物治疗的多发性硬化症患者宫颈癌风险评估：一项队列研究

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Background: Since most patients with relapsing-remitting multiple sclerosis (RRMS) are women, the present study aimed to determine whether treatment of patients with MS by cytotoxic agents is associated with an increased risk of cervical dysplasia. Cancer screening is often neglected in the chronic diseases such as MS, so more attention in this field was needed. Decreasing morbidity and mortality due to cervical cancer is the most important goal of screening in female MS patients especially in child bearing age. Thus, it can be said that this is the first study which investigated this important issue. Methods: A total of 129 individuals participated in this cohort study. They were assigned into 3 groups including 43 patients with MS who were treated with cytotoxic drugs, 43 patients with MS on immunomodulators, and 43 normal healthy controls. Pap smears were performed following standard methods and the results obtained from the three groups were compared by statistical analysis. Demographic data, Expanded Disability Status Scale (EDSS), and Pap smear changes were analyzed by SPSS software. Results: The most commonly detected abnormality in all examined patients and healthy controls was inflammation. Five patients with MS who were treated with cytotoxic agents revealed benign cellular changes (BCC) in their Pap smear that were statistically significant in comparison with other groups (P = 0.03). Patients who took Mitoxantrone presented BCC more than other groups [Odds ratio (OR) = 9.44, 95% confidence interval (CI): 1.46-60.70]. There was no significant difference between mean duration of MS diagnosis (P = 0.12), mean duration of previous MS treatments (P = 0.25), and mean duration of current MS treatments (P = 0.21) in patients with BCC compared to normal healthy controls or inflammatory change. Conclusion: According to the results of present study, BCC is more frequently observed in patients with MS who were treated with cytotoxic agents with immunosuppressive effect. Since BCC is a ‘premalignant condition’, the authors suggest that mandatory annual Pap smear should be performed for patients with MS who are treated with cytotoxic agents irrespective of their age in order to detect early signs of malignancy.
机译：背景：由于大多数患有复发缓解型多发性硬化症（RRMS）的患者均为女性，因此本研究旨在确定通过细胞毒剂治疗MS患者是否与宫颈发育异常的风险增加相关。在诸如MS之类的慢性疾病中，癌症筛查通常被忽略，因此在这一领域需要更多的关注。降低子宫颈癌的发病率和死亡率是女性MS患者（尤其是育龄儿童）筛查的最重要目标。因此，可以说这是研究这一重要问题的第一项研究。方法：共有129人参加了这项队列研究。他们被分为3组，包括43例接受细胞毒性药物治疗的MS患者，43例接受免疫调节剂治疗的MS患者和43例正常健康对照。按照标准方法进行子宫颈抹片检查，并通过统计分析比较从三组获得的结果。通过SPSS软件分析了人口统计学数据，扩展的残疾状况量表（EDSS）和巴氏涂片变化。结果：在所有检查过的患者和健康对照组中，最常见的异常是炎症。五名接受过细胞毒剂治疗的MS患者的巴氏涂片显示良性细胞改变（BCC），与其他组相比具有统计学意义（P = 0.03）。服用米托蒽醌的患者比其他组表现出更多的BCC [几率（OR）= 9.44，95％置信区间（CI）：1.46-60.70]。与正常健康对照组相比，BCC患者的MS诊断平均持续时间（P = 0.12），既往MS治疗的平均持续时间（P = 0.25）和当前MS治疗的平均持续时间（P = 0.21）之间没有显着差异。或炎症改变。结论：根据目前的研究结果，接受细胞免疫药物治疗并具有免疫抑制作用的MS患者中BCC的发生率更高。由于BCC是一种“恶变前状态”，因此作者建议对于接受过细胞毒剂治疗的MS患者，无论其年龄如何，均应进行强制性的年度宫颈涂片检查，以发现恶性的早期征兆。

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