• Laser pretreatment plus PDT has non-inferior efficacy to LEEP in eradicating cervical HSIL and clearing HR-HPV for reproductive-aged women • This combined therapy shows a significantly lower adverse reaction rate (5.26% vs 24.39%) and no cervical adhesion/bleeding complications • It remarkably reduces fertility-related anxiety scores (1.6±1.1 vs 4.2±1.2) in patients seeking fertility preservation • 1:1 PSM is applied to balance baseline confounders, ensuring reliable comparison between the two treatment regimens • The combined therapy achieves 97.37% HR-HPV clearance and cure rates at 12-month follow-up, numerically higher than LEEP This study aimed to evaluate the efficacy, safety, and fertility-related outcomes of laser pretreatment followed by photodynamic therapy versus LEEP in reproductive-aged women with cervical HSIL. This non-randomized controlled prospective study enrolled 79 eligible patients (January 2022 - June 2025) from Minhang Hospital Affiliated to Fudan University, assigned to PDT after laser pretreatment group (Group 1, n=38) or LEEP (Group 2, n=41). One-to-one propensity score matching (PSM) was performed to balance baseline characteristics. The primary efficacy endpoint was histological regression (cure) at 6 and 12 months; HR-HPV clearance was a secondary endpoint. Post-PSM paired analyses used McNemar’s test for categorical variables and paired t-test for continuous variables. Safety and fertility-related anxiety were assessed at 1 month. After PSM (32 matched pairs), the 6‑month histological cure rate was 90.63% in Group 1 and 93.75% in Group 2 (P = 0.617). At 12 months, all patients achieved histological cure in both groups (100% vs. 100%, P = 1.000). The 12‑month HR‑HPV clearance rate was 96.88% versus 87.50% (P = 0.134). The incidence of adverse reactions was significantly lower in Group 1 (3.13% vs. 25.00%, P = 0.034), with no cervical adhesions or bleeding observed. Fertility‑related anxiety scores were also lower in Group 1 (1.6±1.1 vs. 4.2±1.2, P < 0.001); these results were obtained using an unvalidated study‑specific scale and should be regarded as preliminary. Laser pretreatment combined with PDT is non-inferior to LEEP in eradicating cervical HSIL and clearing HR-HPV, while offering superior safety profiles. This organ-preserving strategy represents a reliable option for childbearing-aged women with Type I/II transformation zone HSIL.
Chen et al. (Sun,) studied this question.