Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.
Bogani, G., Lalli, L., Sopracordevole, F., Ciavattini, A., Ghelardi, A., Simoncini, T., Plotti, F., Casarin, J., Serati, M., Pinelli, C., Bergamini, A., Gardella, B., Dell'Acqua, A., Monti, E., Vercellini, P., Palaia, I., Perniola, G., Fischetti, M., Santangelo, G., Fracassi, A., D'Ippolito, G., Aguzzoli, L., Mandato, V. D., Giannella, L., Scaffa, C., Falcone, F., Borghi, C., Malzoni, M., Giannini, A., Salerno, M. G., Liberale, V., Contino, B., Donfrancesco, C., Desiato, M., Perrone, A. M., Dondi, G., De Iaco, P., Ferrero, S., Sarpietro, G., Matarazzo, M. G., Cianci, A., Cianci, S., Bosio, S., Ruisi, S., Mosca, L., Tinelli, R., De Vincenzo, R. P., Zannoni, G. F., Ferrandina, M. G., Petrillo, M., Capobianco, G., Dessiole, S., Carlea, A., Zullo, F., Muschiato, B., Palomba, S., Greggi, S., Spinillo, A., Ghezzi, F., Colacurci, N., Angioli, R., Benedetti Panici, P., Muzii, L., Scambia, G., Raspagliesi, F., Di Donato, V., Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia, <<VACCINES>>, 2022; 10 (4): 579-N/A. [doi:10.3390/vaccines10040579] [http://hdl.handle.net/10807/201163]
Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia
De Vincenzo, Rosa Pasqualina;Zannoni, Gian Franco;Ferrandina, Maria Gabriella;Scambia, Giovanni;
2022
Abstract
Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.
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