High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes.
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Bogani Giorgio, Sopracordevole Francesco, Di Donato Violante, Ciavattini Andrea, Ghelardi Alessandro, Lopez Salvatore, Simoncini Tommaso, Plotti Francesco, Casarin Jvan, Serati Maurizio, Pinelli Ciro, Valenti Gaetano, Bergamini Alice, Gardella Barbara, Dell'acqua Andrea, Monti Ermelinda, Vercellini Paolo, Fischetti Margherita, D'ippolito Giovanni, Aguzzoli Lorenzo, Mandato Vincenzo D, Carunchio Paola, Carlinfante Gabriele, Giannella Luca, Scaffa Cono, Falcone Francesca, Borghi Chiara, Ditto Antonino, Malzoni Mario, Giannini Andrea, Salerno Maria Giovanna, Liberale Viola, Contino Biagio, Donfrancesco Cristina, Desiato Michele, Perrone Anna Myriam, Dondi Giulia, De Iaco Pierandrea, Chiappa Valentina, Ferrero Simone, Sarpietro Giuseppe, Matarazzo Maria G, Cianci Antonio, Bosio Sara, Ruisi Simona, Guerrisi Rocco, Brusadelli Claudia, Mosca Lavinia, Lagana' Antonio Simone, Tinelli Raffaele, Signorelli Mauro, De Vincenzo Rosa, Zannoni Gian Franco, Ferrandina Gabriella, Lovati Sara, Petrillo Marco, Dessole Salvatore, Carlea Annunziata, Zullo Fulvio, Angioli Roberto, Greggi Stefano, Spinillo Arsenio, Ghezzi Fabio, Colacurci Nicola, Muzii Ludovico, Benedetti Panici Pierluigi, Scambia Giovanni, Raspagliesi Francesco
Аннотация
METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had at least 5 years of follow-up. A propensity-score matching was adopted in order to reduce the presence of confounding factors between groups. Kaplan-Meir and Cox hazard models were used to estimate 5-year outcomes.
RESULTS: Overall, data of 2966 women, affected by high-grade cervical dysplasia were reviewed. The study population included 1478 (85%) and 260 (15%) women affected by HR-HPV-positive and HR-HPV-negative high-grade cervical dysplasia. The prevalence of CIN2 and CIN3 among the HR-HPV-positive and -negative cohort was similar (p = 0.315). Patients with HR-HPV-positive high-grade cervical dysplasia were at higher risk of 5-year recurrence (after primary conization) that HR-HPV-negative patients (p < 0.001, log-rank test). Via multivariate analysis, HR-HPV-negative women were at low risk of recurrence (HR: 1.69 (95%CI: 1.05, 4.80); p = 0.018, Cox Hazard model). A propensity-score matched comparison was carried out in order to reduce biases that are related to the retrospective study design. In comparison to HR-HPV-negative patients, thosewith HR-HPV-positive CIN3 was associate with a 8-fold increase in the risk of recurrence (p < 0.001, log-rank test).
CONCLUSIONS: HR-HPV-negative high-grade cervical dysplasia is not uncommon, accounting for 15% of our study population. Those patients experience more favorable outcomes than patients with documented HR-HPV infection(s). Further prospective studies are needed to corroborate our data.