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KMID : 1137020200310050060
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Journal of Gynecologic Oncology
2020 Volume.31 No. 5 p.60 ~ p.60
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Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women
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Bogani Giorgio
Pinelli Ciro
Chiappa Valentina
Martinelli Fabio
Lopez Salvatore
Ditto Antonino
Raspagliesi Francesco
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Abstract
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Objective: This study aimed to identify predictors of recurrence/persistence of cervical intraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization.
Methods: Retrospective analysis involving all consecutive women having conization for CIN2+ between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models.
Results: Data of 3,212 women were retrospectively identified. After a mean follow-up of 47 (±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between prior conization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis, presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis, hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66?6.95) for HPV16/18 and HR=2.59 (95% CI=1.21?5.55) for HPV types other than 16/18, positive margins at primary conization, HR=4.11 (95% CI=2.04?8.26) and HPV persistence after conization, HR=16.69 (95% CI=8.20?33.9), correlated with r-CIN2+, independently. Considering age-specific HPV types distribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+ only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population (>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test).
Conclusion: HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18 has a detrimental effect in young women, thus highlighting the need of implementing vaccination against HPV in this population. Further prospective studies are warranted for tailoring clinical decision-making for post-conization follow-up on the basis of risk factors.
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KEYWORD
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Human Papillomavirus 16, Conization, Papillomavirus Infections, Squamous Intraepithelial Lesions of the Cervix
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