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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
Author(s) -
FernándezMontolí ME,
Tous S,
Medina G,
Castellarnau M,
GarcíaTejedor A,
Sanjosé S
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15996
Subject(s) - medicine , cervical intraepithelial neoplasia , colposcopy , hazard ratio , odds ratio , confidence interval , retrospective cohort study , gynecology , proportional hazards model , population , logistic regression , obstetrics , cervical cancer , cancer , environmental health
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 <0.001). Conclusions 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. Tweetable abstract After LLETZ for CIN 2–3, recurrences appear more often in women with positive HR‐HPV and involved margins and aged over 35.