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    Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women

    Journal of Gynecologic Oncology 2020년 31권 5호 p.60 ~ 60
    Bogani Giorgio, Pinelli Ciro, Chiappa Valentina, Martinelli Fabio, Lopez Salvatore, Ditto Antonino, Raspagliesi Francesco,
    소속 상세정보
     ( Bogani Giorgio ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Pinelli Ciro ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Chiappa Valentina ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Martinelli Fabio ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Lopez Salvatore ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Ditto Antonino ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
     ( Raspagliesi Francesco ) 
    Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
    KMID : 1137020200310050060    DOI : 10.3802/jgo.2020.31.e60

    Abstract


    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.

    키워드

    Human Papillomavirus 16; Conization; Papillomavirus Infections; Squamous Intraepithelial Lesions of the Cervix

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