We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Long-term predictors of residual or recurrent cervical intraepithelial neoplasia 2-3 after treatment with a large loop excision of the transformation zone: a retrospective study.
- Authors
Fernández‐Montolí, M‐E; Tous, S; Medina, G; Castellarnau, M; García‐Tejedor, A; Sanjosé, S; Fernández-Montolí, M-E; García-Tejedor, A; de Sanjosé, S
- Abstract
<bold>Objective: </bold>To assess the long-term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2-3) and time to recurrence after large loop excision of the transformation zone (LLETZ).<bold>Design: </bold>Retrospective study.<bold>Setting: </bold>Colposcopy clinic.<bold>Population: </bold>242 women with CIN 2-3 treated between 1996 and 2006 and followed up until June 2016.<bold>Methods: </bold>Age, margins, and high-risk human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan-Meier analysis.<bold>Main Outcome Measure: </bold>Histologically confirmed CIN 2-3, HR-HPV, margins, age.<bold>Results: </bold>CIN 2-3 was associated with HR-HPV (HR = 30.5, 95% confidence interval [CI] = 3.80-246.20), age >35 years (HR = 5.53, 95% CI = 1.22-25.13), and margins (HR = 7.31, 95% CI = 1.60-33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto+ /endocervical+ (16.7%), uncertain (19.4%) and ecto- /endocervical+ margins (9.1%) showed a higher risk of recurrence (odds ratio [OR] = 13.20, 95% CI = 1.02-170.96; OR = 15.84, 95% CI = 3.02-83.01; and OR = 6.60, 95% CI = 0.88-49.53, respectively). Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001).<bold>Conclusions: </bold>HR-HPV and margins seem essential for stratifying post-LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women to reduce the risk.<bold>Tweetable Abstract: </bold>After LLETZ for CIN 2-3, recurrences appear more often in women with positive HR-HPV and involved margins and aged over 35.
- Subjects
SPAIN; CERVICAL intraepithelial neoplasia; OLDER women; RETROSPECTIVE studies; LOGISTIC regression analysis; REGRESSION analysis; CERVIX uteri surgery; PAPILLOMAVIRUS disease diagnosis; CARCINOGENESIS; CANCER relapse; CERVIX uteri; PAPILLOMAVIRUS diseases; RISK assessment; CERVIX uteri tumors; KAPLAN-Meier estimator; NEOPLASTIC cell transformation
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2020, Vol 127, Issue 3, p377
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.15996