Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women.
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.
['Bogani|Giorgio|G|https://orcid.org/0000-0001-8373-8569', 'Pinelli|Ciro|C|https://orcid.org/0000-0003-2375-9522', 'Chiappa|Valentina|V|https://orcid.org/0000-0002-1811-209X', 'Martinelli|Fabio|F|https://orcid.org/0000-0002-4863-1747', 'Lopez|Salvatore|S|https://orcid.org/0000-0001-7705-3715', 'Ditto|Antonino|A|https://orcid.org/0000-0002-5684-8225', 'Raspagliesi|Francesco|F|https://orcid.org/0000-0001-8953-1657']
D000328:Adult D000367:Age Factors D018290:Cervical Intraepithelial Neoplasia D019092:Conization D005260:Female D052162:Human papillomavirus 16 D052161:Human papillomavirus 18 D006801:Humans D008875:Middle Aged D009364:Neoplasm Recurrence, Local D027383:Papillomaviridae D030361:Papillomavirus Infections D011446:Prospective Studies D012189:Retrospective Studies D002583:Uterine Cervical Neoplasms
Conization Human Papillomavirus 16 Papillomavirus Infections Squamous Intraepithelial Lesions of the Cervix