Abstract

OBJECTIVE
To evaluate the risk factors potentially involved in the development of cervical intraepithelial neoplasia (CIN) recurrence after cervical conization in a long-term follow-up period.
STUDY DESIGN
Consecutive patients with histologically proven CIN who had undergone either cold knife conization or a loop electrosurgical excision procedure were enrolled and scheduled for serial follow-up examinations over a 10-year period. Data were stored in a digital database. Multivariate analysis was performed to identify factors for recurrence.
RESULTS
Between January 1999 and December 2009, 282 patients fulfilled the inclusion criteria and were included in the final statistical analysis. After a median follow-up of 26.7 months (range 6-100), 64 (22.7%) women developed histologically confirmed recurrence. The 2-year recurrence-free survival was 83.7% and 66.7% for women with negative and positive margins, respectively (p=0.008). The 5-year recurrence-free survival was 75.4% and 50.3% for patients with negative and positive margins, respectively (p=0.0004). Positive surgical margin was the most important independent predictor of recurrence [HR 2.5 (95%CI 1.5-4.5), p=0.0007; Wald 11.338]. After multinomial logistic regression the indication for conization based on persistent CIN1 was the only independent predictor for negative margin [OR 0.3 (95%CI 0.1-0.7), p=0.008].
CONCLUSIONS
Our study demonstrated that the surgical margin status represents the most important predictor for CIN recurrence after conization. After excisional therapy, close follow-up is mandatory for the early detection of recurrent disease. The identification of risk factors for recurrence may guide clinical decision-making on expectant management versus re-intervention.

Links

Publisher Full Text

Authors

Serati M, Siesto G, Carollo S, Formenti G, Riva C, Cromi A, Ghezzi F

Institution

Dept. of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy. mauserati@hotmail.com

Source

European journal of obstetrics, gynecology, and reproductive biology 165:1 2012 Nov pg 86-90

MeSH

Adolescent
Adult
Aged
Cervical Intraepithelial Neoplasia
Cervix Uteri
Cohort Studies
Conization
Female
Follow-Up Studies
Humans
Italy
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local
Predictive Value of Tests
Retrospective Studies
Risk Factors
Survival Analysis
Uterine Cervical Neoplasms
Young Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22771223