Bogani Giorgio, Lalli Luca, Sopracordevole Francesco, Ciavattini Andrea, Ghelardi Alessandro, Simoncini Tommaso, Plotti Francesco, Casarin Jvan, Serati Maurizio, Pinelli Ciro, Bergamini Alice, Gardella Barbara, Dell'Acqua Andrea, Monti Ermelinda, Vercellini Paolo, Palaia Innocenza, Perniola Giorgia, Fischetti Margherita, Santangelo Giusi, Fracassi Alice, D'Ippolito Giovanni, Aguzzoli Lorenzo, Mandato Vincenzo Dario, Giannella Luca, Scaffa Cono, Falcone Francesca, Borghi Chiara, Malzoni Mario, Giannini Andrea, Salerno Maria Giovanna, Liberale Viola, Contino Biagio, Donfrancesco Cristina, Desiato Michele, Perrone Anna Myriam, Dondi Giulia, De Iaco Pierandrea, Ferrero Simone, Sarpietro Giuseppe, Matarazzo Maria G, Cianci Antonio, Cianci Stefano, Bosio Sara, Ruisi Simona, Mosca Lavinia, Tinelli Raffaele, De Vincenzo Rosa, Zannoni Gian Franco, Ferrandina Gabriella, Petrillo Marco, Capobianco Giampiero, Dessiole Salvatore, Carlea Annunziata, Zullo Fulvio, Muschiato Barbara, Palomba Stefano, Greggi Stefano, Spinillo Arsenio, Ghezzi Fabio, Colacurci Nicola, Angioli Roberto, Benedetti Panici Pierluigi, Muzii Ludovico, Scambia Giovanni, Raspagliesi Francesco, Di Donato Violante
Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
Vaccines (Basel). 2022 Apr 9;10(4):579. doi: 10.3390/vaccines10040579.
Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.
宫颈发育异常的持续/复发对女性健康和生活质量有很大影响。在本研究中，我们调查了一种预后列线图是否可以改善初次锥切术后的风险评估。这是一项基于2010年1月1日至2014年12月31日期间连续接受锥切术患者病历的回顾性多机构研究。构建了一个评估不同变量重要性的列线图。使用一组在2015年1月1日至2016年6月30日期间接受治疗的患者来验证该列线图。总共分析了2966例接受初次锥切术的患者。患者年龄中位数（范围）为40（18 - 89）岁。在5年的随访中，6%的患者（175/2966）出现了持续性/复发性宫颈发育异常。无复发生存期的中位数（范围）为18（5 - 52）个月。CIN3的诊断、高危型人乳头瘤病毒（HR - HPV）类型的存在、宫颈管切缘阳性、HPV持续存在以及锥切术后未接种HPV疫苗均显著且独立地增加了发生宫颈发育异常持续/复发的风险。构建了一个权衡所有变量影响的列线图，C指数为0.809。使用一个包含549例患者的数据集来验证该列线图，C指数为0.809。本列线图是一种有用的工具，可用于向女性咨询其初次锥切术后持续/复发的风险。锥切术后接种HPV疫苗与CIN2 +风险降低相关。
