Long-Term Clinical Outcome after Treatment for High-Grade Cervical Lesions: A Retrospective Monoinstitutional Cohort Study

Abstract

Background. The aim of this retrospective observational study of women treated for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was to assess the long-term risk of residual/recurrent high-grade CIN. Materials and Methods. We evaluated 760 women treated by loop electrosurgical excision procedure (684) or conization (76) between 2000 and 2009, and followed up to June 30, 2014 (median follow-up 6.7 years, range 4–14). Visits every 6 months for the first year after treatment and yearly for up to the following 10 years included cytology, colposcopy when indicated, and HPV testing (search and typing). Results. CIN2+ or vaginal intraepithelial neoplasia grade 2 or worse (VAIN2+) was detected in 67 cases (8.8%), 39 at first follow-up and 28 after one/more negative visits. The risk of CIN2+ was higher in case of positive margins (odds ratio (OR) 8.04, 95% CI 4.31–15.0), type 3 transformation zone (OR for CIN3 27.7, 95% CI 2.07–36.9), CIN3+ excision (OR 6.02, 95% CI 1.73–20.9), and positive high-risk HPV test at first follow-up (OR for HPV16: 20.6, 95% CI 6.8–62.6; OR for other hrHPV types: 18.3, 95% CI 5.9–57.0). Conclusion. Residual/recurrent high-grade CIN occurred in <9% cases, and the risk was associated with transformation zone type, lesion grade, margins status, and hrHPV test result at 6–12 months of follow-up.

<p>Barriers and facilitators of follow-up among women with precancerous lesions of the cervix in Cameroon: a qualitative pilot study</p>

“…The most important part of cervical cancer secondary prevention is not just identifying and treating precancer but also allowing for sequential follow-up of women who screen positive and/or treated for precancerous lesions 4. Follow-up entails treatment of the lesions and post-treatment surveillance to monitor lesion recurrence 5. The purpose of this study was to understand the barriers and facilitators to post-cervical cancer screening follow-up among individual patients and groups of nurses who care for them.…”

<p>Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3</p>

“…Several previous studies have evaluated clinical and pathological predictors of the persistence of or residual CIN and cervical cancer. 3,[5][6][7][8][9][10][13][14][15][16][17] However, only a few studies have examined whole uterine specimens after hysterectomy 13 and have focused on post-menopausal patients alone. These studies differ from each other methodologically, including the study populations and analysis of variables.…”

“…2 Studies have reported that residual disease or recurrence of CIN 2+ after treatment ranges from 1.1% to 17.7%. [3][4][5][6][7][8][9][10][11] In addition, the risk for cervical cancer in patients treated for CIN 2-3 can be fivefold higher than that in the general population. 12 Therefore, to make more appropriate management decisions in clinical practice, many researchers have investigated risk factors that may predict residual disease after treatment for CIN 2-3.…”

“…12 Therefore, to make more appropriate management decisions in clinical practice, many researchers have investigated risk factors that may predict residual disease after treatment for CIN 2-3. 3,[5][6][7][8][9][10][13][14][15][16][17] Some have found that menopausal status 17 and older age (>45 years) 15 are associated with a higher risk for residual disease after cervical conization. This specific group of post-menopausal or older patients needs more attention during treatment.…”

CDK9 Inhibitor FIT-039 Suppresses Viral Oncogenes E6 and E7 and Has a Therapeutic Effect on HPV-Induced Neoplasia

“…Incidences of CIN and cervical cancer, therefore, are increasing in those countries, especially among women of reproductive ages, which leaves cervical cancer still among the leading causes of cancer-related deaths in the world. The standard care for CIN is cervical cornification, which, however, increases risk of premature birth and newborn mortality due to a compromised cervix function (11)(12)(13)(14) and nearly 10% of recurrence risk by persisting HPV infection (15,16), and noninvasive therapeutics has been demanded for CIN treatment. Thus, in this study, we examined anti-HPV compound for a therapeutic effect on HPV-induced CIN and cervical cancer.…”