Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Bogani Giorgio, DI Donato Violante, Sopracordevole Francesco, 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, Leone Roberti Maggiore Umberto, Signorelli Mauro, Chiappa Valentina, Ferrero Simone, Sarpietro Giuseppe, Matarazzo Maria G, Cianci Antonio, Bosio Sara, Ruisi Simona, Guerrisi Rocco, Brusadelli Claudia, Mosca Lavinia, Tinelli Raffaele, DE Vincenzo Rosa, Zannoni Gian Franco, Ferrandina Gabriella, Petrillo Marco, Dessole Salvatore, 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 HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models.
RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001).
CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.