Vaccines, Vol. 11, Pages 698: Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization

Vaccines, Vol. 11, Pages 698: Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization

Vaccines doi: 10.3390/vaccines11030698

Authors: Andrea Giannini Violante Di Donato Francesco Sopracordevole Andrea Ciavattini Alessandro Ghelardi Enrico Vizza Ottavia D’Oria Tommaso Simoncini Francesco Plotti Jvan Casarin Tullio Golia D’Augè Ilaria Cuccu Maurizio Serati Ciro Pinelli Alice Bergamini Barbara Gardella Andrea Dell’Acqua Ermelinda Monti Paolo Vercellini Giovanni D’Ippolito Lorenzo Aguzzoli Vincenzo Dario Mandato Luca Giannella Cono Scaffa Antonino Ditto Francesca Falcone Chiara Borghi Mario Malzoni Alessandra Di Giovanni Maria Giovanna Salerno Viola Liberale Biagio Contino Cristina Donfrancesco Michele Desiato Anna Myriam Perrone Pierandrea De Iaco Simone Ferrero Giuseppe Sarpietro Maria G. Matarazzo Antonio Cianci Stefano Cianci Sara Bosio Simona Ruisi Lavinia Mosca Raffaele Tinelli Rosa De Vincenzo Gian Franco Zannoni Gabriella Ferrandina Marco Petrillo Giampiero Capobianco Annunziata Carlea Fulvio Zullo Barbara Muschiato Stefano Palomba Stefano Greggi Arsenio Spinillo Fabio Ghezzi Nicola Colacurci Roberto Angioli Pierluigi Benedetti Panici Ludovico Muzii Giovanni Scambia Francesco Raspagliesi Giorgio Bogani

The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervical lesions. All patients included had both positive surgical margins and experienced HPV persistence at 6 months. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). The charts of 2966 patients undergoing conization were reviewed. Among the whole population, 163 (5.5%) patients met the inclusion criteria, being at high risk due to the presence of positive surgical margins and experiencing HPV persistence. Of 163 patients included, 17 (10.4%) patients developed a CIN2+ recurrence during the 5-year follow-up. Via univariate analyses, diagnosis of CIN3 instead of CIN2 (HR: 4.88 (95%CI: 1.10, 12.41); p = 0.035) and positive endocervical instead of ectocervical margins (HR: 6.44 (95%CI: 2.80, 9.65); p < 0.001) were associated with increased risk of persistence/recurrence. Via multivariate analyses, only positive endocervical instead of ectocervical margins (HR: 4.56 (95%CI: 1.23, 7.95); p = 0.021) were associated with worse outcomes. In this high-risk group, positive endocervical margins is the main risk factor predicting 5-year recurrence.