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Showing content from https://pubmed.ncbi.nlm.nih.gov/34434283/ below:

Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment

doi: 10.3892/ol.2021.12945. Epub 2021 Jul 27. Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment

Affiliations

¹ Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.
² Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.
³ School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.
⁴ Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA.
⁵ School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden.

PMID: 34434283
PMCID: PMC8335741
DOI: 10.3892/ol.2021.12945

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Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment

Sonia Andersson et al. Oncol Lett. 2021 Sep.

doi: 10.3892/ol.2021.12945. Epub 2021 Jul 27. Affiliations

¹ Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.
² Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.
³ School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.
⁴ Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA.
⁵ School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden.

PMID: 34434283
PMCID: PMC8335741
DOI: 10.3892/ol.2021.12945

Item in Clipboard

Abstract

The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4-6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3-9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0-14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0-16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4-11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.

Keywords: age; cervical intraepithelial neoplasia; margin status; papillomavirus infection; treatment failure.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures
Figure 1.

Flow chart of how the…

Figure 1.

Flow chart of how the patients were triaged. The shaded rectangles highlight the…

Figure 1.

Flow chart of how the patients were triaged. The shaded rectangles highlight the patients in whom recurrence was detected in relation to the follow-up procedures. HPV, high-risk human papillomavirus.