Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization

Giannini, A.; Di Donato, V.; Sopracordevole, F.; Ciavattini, A.; Ghelardi, A.; Vizza, E.; D’Oria, O.; Simoncini, T.; Plotti, F.; Casarin, J.; Golia D’Augè, T.; Cuccu, I.; Serati, M.; Pinelli, C.; Bergamini, A.; Gardella, B.; Dell’Acqua, A.; Monti, E.; Vercellini, P.; D’Ippolito, G.; Aguzzoli, L.; Dario Mandato, V.; Giannella, L.; Scaffa, C.; Ditto, A.; Falcone, F.; Borghi, C.; Malzoni, M.; Di Giovanni, A.; Salerno, M. G.; Liberale, V.; Contino, B.; Donfrancesco, C.; Desiato, M.; Perrone, A. M.; De Iaco, P.; Ferrero, S.; Sarpietro, G.; Matarazzo, M. G.; Cianci, A.; Cianci, S.; Bosio, S.; Ruisi, S.; Mosca, L.; Tinelli, R.; De Vincenzo, Rosa Pasqualina; Zannoni, Gian Franco; Ferrandina, Maria Gabriella; Petrillo, M.; Capobianco, G.; Carlea, A.; Zullo, F.; Muschiato, B.; Palomba, S.; Greggi, S.; Spinillo, A.; Ghezzi, F.; Colacurci, N.; Angioli, R.; Benedetti Panici, P.; Muzii, L.; Scambia, Giovanni; Raspagliesi, F.; Bogani, G.

doi:10.3390/vaccines11030698

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.

Giannini, A., Di Donato, V., Sopracordevole, F., Ciavattini, A., Ghelardi, A., Vizza, E., D’Oria, O., Simoncini, T., Plotti, F., Casarin, J., Golia D’Augè, T., Cuccu, I., Serati, M., Pinelli, C., Bergamini, A., Gardella, B., Dell’Acqua, A., Monti, E., Vercellini, P., D’Ippolito, G., Aguzzoli, L., Dario Mandato, V., Giannella, L., Scaffa, C., Ditto, A., Falcone, F., Borghi, C., Malzoni, M., Di Giovanni, A., Salerno, M. G., Liberale, V., Contino, B., Donfrancesco, C., Desiato, M., Perrone, A. M., 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., 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., Bogani, G., Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization, <<VACCINES>>, 2023; 11 (3): 698-708. [doi:10.3390/vaccines11030698] [https://hdl.handle.net/10807/236354]