Department of Gynecologic Oncology.
Department of Immunohematology and Transfusion Medicine Service, IRCCS National Cancer Institute, Milan, Italy.
Eur J Cancer Prev. 2019 Sep;28(5):435-440. doi: 10.1097/CEJ.0000000000000475.
The widespread introduction of screening methods allow to identify cervical dysplasia before having invasive cancer. The risk of developing cervical dysplasia persistence/ recurrence following conization represent a major health issue. Although several studies tried to identify predictors for cervical dysplasia persistence/recurrence, no previous study has been conducted to develop a risk calculator. The current study aimed to identify predictors of cervical dysplasia persistence/recurrence among women undergoing primary conization. We aimed to build nomograms estimating the risk of developing cervical dysplasia recurrence. Data of consecutive women with diagnosis of high-risk human papillomavirus (HPV) undergoing conization were retrospectively evaluated (1503 patients). The risk of developing cervical dysplasia persistence/recurrence was assessed with Kaplan-Meier and Cox's hazard models. Additionally, two nomograms were built to estimate likelihood of cervical dysplasia recurrence: the first based on baseline and operative parameters and the second focusing on type-specific HPV detected. The performance of the above nomograms was assessed using concordance index. A total of 1503 patients were analyzed. After a mean (SD) follow-up of 48.6 ( ± 17.5) months, 84 (5.6%) patients required secondary conization. By multivariate analysis, HIV infection [hazard ratio (HR): 7.78; 95% confidence interval (CI): 2.77-21.81; P < 0.001], positive margins (HR: 26.2; 95% CI: 14.1-48.71; P < 0.001) and persistence of HPV (HR: 6.82; 95% CI: 4.15-11.21; P < 0.001) correlated with cervical intraepithelial neoplasia 2+ persistence/recurrence. The importance of those variables was corroborated by our first nomogram. The second nomogram suggested the impact of type-specific HPV infection in predicting cervical dysplasia persistence/ recurrence. HPV16, HPV18, HPV33, HPV35 and HPV45 were the HPV types most commonly associated with cervical dysplasia persistence/recurrence. The concordance index was greater than 0.70 for both nomograms, thus suggesting the reproducibility of our models. We developed the first two nomograms predicting this risk. The findings of this study require external validation. Once validated our data might be useful to plan a tailored postoperative surveillance of women receiving primary conization.
筛查方法的广泛应用使得在发生浸润性宫颈癌之前能够识别宫颈上皮内瘤变。锥切术后宫颈上皮内瘤变持续/复发的风险是一个主要的健康问题。尽管有几项研究试图确定宫颈上皮内瘤变持续/复发的预测因素，但尚未有研究开发风险计算器。本研究旨在确定行初次锥切术的女性中宫颈上皮内瘤变持续/复发的预测因素。我们旨在建立估计宫颈上皮内瘤变复发风险的列线图。回顾性评估了诊断为高危型人乳头瘤病毒（HPV）并接受锥切术的连续女性患者的数据（1503 例患者）。采用 Kaplan-Meier 和 Cox 风险模型评估发生宫颈上皮内瘤变持续/复发的风险。此外，建立了两个列线图来估计宫颈上皮内瘤变复发的可能性：第一个基于基线和手术参数，第二个侧重于检测到的特定 HPV 类型。通过一致性指数评估上述列线图的性能。共分析了 1503 例患者。平均（SD）随访 48.6（±17.5）个月后，84 例（5.6%）患者需要二次锥切术。多变量分析显示，HIV 感染[风险比（HR）：7.78；95%置信区间（CI）：2.77-21.81；P<0.001]、阳性切缘（HR：26.2；95%CI：14.1-48.71；P<0.001）和 HPV 持续存在（HR：6.82；95%CI：4.15-11.21；P<0.001）与宫颈上皮内瘤变 2+持续/复发相关。第一个列线图证实了这些变量的重要性。第二个列线图提示特定 HPV 感染在预测宫颈上皮内瘤变持续/复发中的作用。HPV16、HPV18、HPV33、HPV35 和 HPV45 是与宫颈上皮内瘤变持续/复发最相关的 HPV 类型。两个列线图的一致性指数均大于 0.70，提示模型具有可重复性。我们开发了前两个预测这种风险的列线图。这些研究结果需要外部验证。一旦验证，我们的数据可能有助于为接受初次锥切术的女性制定个性化的术后监测计划。
