Risk factors for recurrent disease after loop electrosurgical excision procedure in patients with cervical intraepithelial neoplasia: a systematic review and meta-analysis.

BACKGROUND

Loop electrosurgical excision procedure (LEEP) is a widely used treatment for cervical intraepithelial neoplasia (CIN). However, some patients remain at risk of residual or recurrent disease after treatment. Identifying predictors of recurrence is important for improving postoperative surveillance and individualized management. This systematic review and meta-analysis aimed to synthesize the available evidence on risk factors for recurrent disease after LEEP in patients with CIN.

METHODS

PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, WanFang, and VIP databases were searched from inception to February 10, 2026. Observational studies reporting factors associated with recurrent disease after LEEP in patients with CIN were eligible. Literature screening, data extraction, and quality assessment were independently conducted by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were performed using Stata 15.0. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 17 studies involving 8,347 patients were included. The pooled analysis showed that positive surgical margins (OR = 4.55, 95% CI: 3.00-6.90), persistent hr-HPV infection (OR = 10.44, 95% CI: 7.77-14.03), higher-grade lesions (OR = 1.85, 95% CI: 1.27-2.70), smoking (OR = 2.09, 95% CI: 1.34-3.25), and older age (OR = 1.32, 95% CI: 1.08-1.61) were significantly associated with an increased risk of recurrent disease after LEEP.

CONCLUSIONS

Positive surgical margins, persistent hr-HPV infection, higher-grade lesions, and smoking appear to be important risk factors for recurrent disease after LEEP in patients with CIN. Older age may also be associated with recurrence, although this finding should be interpreted with caution because of potential publication bias. These findings may help inform postoperative risk stratification and individualized follow-up strategies in this population.