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

• Published in: BJOG : an international journal of obstetrics and gynaecology 2020-02, Vol.127 (3), p.377-387
• Main Authors: Fernández‐Montolí, M‐E, Tous, S, Medina, G, Castellarnau, M, García‐Tejedor, A, Sanjosé, S
• Format: Article
• Language: English
• Subjects: Age; Cell Transformation, Neoplastic; Cervical cancer; Cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - surgery; Cervix Uteri - pathology; Cervix Uteri - surgery; Clinical outcomes; Colposcopy; Disease prevention; Female; Health risk assessment; HPV; Human papillomavirus; Humans; Kaplan-Meier Estimate; Long Term Adverse Effects - diagnosis; Long Term Adverse Effects - epidemiology; margin status; Margins of Excision; Medical procedures; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm, Residual - diagnosis; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; recurrence; Regression analysis; Retrospective Studies; Risk Assessment - methods; Risk factors; Spain - epidemiology; Trachelectomy - adverse effects; Trachelectomy - methods; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15996

Objective 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). Design Retrospective study. Setting Colposcopy clinic. Population 242 women with CIN 2–3 treated between 1996 and 2006 and followed up until June 2016. Methods 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. Main outcome measure Histologically confirmed CIN 2–3, HR‐HPV, margins, age. Results 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