Frontiers in public health · 2026
Informative HPV testing after conization and its impact on time-varying estimates: a GAMM-based cohort study.
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Zhou Jie, Liao Jian Hong, Su Lin Jie, Chen Yan, Hu Hong Bo
Аннотация
OBJECTIVES: To characterize post-conization time-varying HPV positivity trajectories in a real-world setting with irregular follow-up, and to assess whether the association between baseline infection multiplicity (single vs. multiple) and postoperative HPV positivity is robust to testing intensity and potential informative visiting.
METHODS: In this retrospective cohort of 872 women who underwent conization and completed ≥1 postoperative HPV test, we modeled HPV positivity (yes/no) over continuous months since conization using generalized additive mixed models with subject-specific random effects. Time-varying between-group differences were evaluated using a group-specific time-varying parameter. To address irregular follow-up and potential informative visiting, we performed prespecified sensitivity analyses by (i) restricting to women with ≥3 postoperative HPV tests and (ii) additionally adjusting for testing intensity (number of HPV tests during follow-up). Models adjusted for age, menopausal status, admission type, health insurance type, margin status, preoperative cytology, gravidity/parity, and postoperative hysterectomy.
RESULTS: In the overall cohort, postoperative HPV positivity decreased over time in both groups (per 4 months: single infection OR = 0.66, 95% CI 0.63-0.70; multiple infection OR = 0.71, 95% CI 0.65-0.78; both P < 0.0001). Multiple infection was associated with a persistently higher time-varying trajectory (OR = 1.22, 95% CI 1.12-1.32; P < 0.0001), with differences concentrated in the early-to-mid follow-up period. Findings were consistent in sensitivity analyses restricting to women with ≥3 tests and after adjustment for testing intensity.
CONCLUSIONS: Post-conization HPV testing occurs under irregular, potentially informative follow-up in real-world practice. Accounting for testing intensity, the association between baseline multiple infection and less favorable time-varying postoperative trajectories remained robust, supporting risk-stratified surveillance while highlighting the need to explicitly consider follow-up patterns when estimating postoperative HPV dynamics.
METHODS: In this retrospective cohort of 872 women who underwent conization and completed ≥1 postoperative HPV test, we modeled HPV positivity (yes/no) over continuous months since conization using generalized additive mixed models with subject-specific random effects. Time-varying between-group differences were evaluated using a group-specific time-varying parameter. To address irregular follow-up and potential informative visiting, we performed prespecified sensitivity analyses by (i) restricting to women with ≥3 postoperative HPV tests and (ii) additionally adjusting for testing intensity (number of HPV tests during follow-up). Models adjusted for age, menopausal status, admission type, health insurance type, margin status, preoperative cytology, gravidity/parity, and postoperative hysterectomy.
RESULTS: In the overall cohort, postoperative HPV positivity decreased over time in both groups (per 4 months: single infection OR = 0.66, 95% CI 0.63-0.70; multiple infection OR = 0.71, 95% CI 0.65-0.78; both P < 0.0001). Multiple infection was associated with a persistently higher time-varying trajectory (OR = 1.22, 95% CI 1.12-1.32; P < 0.0001), with differences concentrated in the early-to-mid follow-up period. Findings were consistent in sensitivity analyses restricting to women with ≥3 tests and after adjustment for testing intensity.
CONCLUSIONS: Post-conization HPV testing occurs under irregular, potentially informative follow-up in real-world practice. Accounting for testing intensity, the association between baseline multiple infection and less favorable time-varying postoperative trajectories remained robust, supporting risk-stratified surveillance while highlighting the need to explicitly consider follow-up patterns when estimating postoperative HPV dynamics.