Leguevaque P, Motton S, Decharme A, Soulé-Tholy M, Escourrou G, Hoff J. Predictors of recurrence in high-grade cervical lesions and a plan of management.
Eur J Surg Oncol 2010;
36:1073-9. [PMID:
20870375 DOI:
10.1016/j.ejso.2010.08.135]
[Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 07/21/2010] [Accepted: 08/19/2010] [Indexed: 10/19/2022] Open
Abstract
UNLABELLED
PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended.
OBJECTIVE
To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up.
DESIGN
prospective pilot study.
SETTING
Gynaecological surgical center.
POPULATION
Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions.
METHODS
According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment.
MAIN OUTCOME MEASURES
underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up.
RESULTS
Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment.
CONCLUSION
In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.
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