Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study.,Gynecologic Oncology

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Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study.
Gynecologic Oncology ( IF 4.5 ) Pub Date : 2020-09-03 , DOI: 10.1016/j.ygyno.2020.08.025
Giorgio Bogani ₁ , Violante DI Donato ₂ , Francesco Sopracordevole ₃ , Andrea Ciavattini ₄ , Alessandro Ghelardi ₅ , Salvatore Lopez ₁ , Tommaso Simoncini ₆ , Francesco Plotti ₇ , Jvan Casarin ₈ , Maurizio Serati ₈ , Ciro Pinelli ₉ , Gaetano Valenti ₃ , Alice Bergamini ₁₀ , Barbara Gardella ₁₁ , Andrea Dell'acqua ₁₂ , Ermelinda Monti ₁₂ , Paolo Vercellini ₁₂ , Margherita Fischetti ₂ , Giovanni D'Ippolito ₁₃ , Lorenzo Aguzzoli ₁₃ , Vincenzo D Mandato ₁₃ , Paola Carunchio ₁₃ , Gabriele Carlinfante ₁₃ , Luca Giannella ₄ , Cono Scaffa ₁₄ , Francesca Falcone ₁₄ , Chiara Borghi ₁₅ , Antonino Ditto ₁ , Mario Malzoni ₁₆ , Andrea Giannini ₁₇ , Maria Giovanna Salerno ₁₇ , Viola Liberale ₁₈ , Biagio Contino ₁₈ , Cristina Donfrancesco ₁₉ , Michele Desiato ₁₉ , Anna Myriam Perrone ₂₀ , Giulia Dondi ₂₀ , Pierandrea De Iaco ₂₀ , Umberto Leone Roberti Maggiore ₁ , Mauro Signorelli ₁ , Valentina Chiappa ₁ , Simone Ferrero ₂₁ , Giuseppe Sarpietro ₂₂ , Maria G Matarazzo ₂₂ , Antonio Cianci ₂₂ , Sara Bosio ₂₃ , Simona Ruisi ₂₃ , Rocco Guerrisi ₉ , Claudia Brusadelli ₉ , Lavinia Mosca ₂₄ , Raffaele Tinelli ₂₅ , Rosa DE Vincenzo ₂₆ , Gian Franco Zannoni ₂₆ , Gabriella Ferrandina ₂₆ , Marco Petrillo ₂₇ , Salvatore Dessole ₂₇ , Roberto Angioli ₇ , Stefano Greggi ₁₄ , Arsenio Spinillo ₁₁ , Fabio Ghezzi ₂₈ , Nicola Colacurci ₂₄ , Ludovico Muzii ₂ , Pierluigi Benedetti Panici ₂ , Giovanni Scambia ₂₆ , Francesco Raspagliesi ₁

Affiliation

Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy.
Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy.
Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy.
Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Campus Bio-Medico University of Rome, Italy.
Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy.
Ospedale di circolo Fondazione Macchi, Varese, Italy.
Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy.
IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.
Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
Department of Obstetrics and Gynecology, S. Anna University Hospital, Ferrara, Italy.
Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy.
Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy.
Department of Obstetrics and Gynecology, Azienda ASL, Frosinone, Ospedale S Trinità di Sora, Sora, Iatly.
Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy.
Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124, Catania, Italy.
San Paolo Hospital, Università degli Studi di Milano, 20142, Milan, Italy.
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, via San Francesco da Paola, 74015, Taranto, Italy.
UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.
Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy; Ospedale di circolo Fondazione Macchi, Varese, Italy.

Objective

Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+).

Methods

This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models.

Results

Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001).

Conclusions

HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.

中文翻译：

循环电外科切除术（LEEP）和激光锥切术后的复发率：一项为期5年的随访研究。

目的

锥切术旨在去除子宫颈的肿瘤前病变。比较了几种锥切技术，但是关于最有效的治疗选择的证据很少。在这里，我们旨在比较高级别宫颈发育不良（HSIL / CIN2 +）患者的激光锥切术和环电外科切除术（LEEP）后的复发率。

方法

这是一项回顾性的多机构研究。检索了2010年至2014年间连续接受锥切术的HSIL / CIN2 +患者的病历。应用倾向得分匹配（PSM）以减少分配偏差。使用Kaplan-Meir和Cox危害模型评估了复发的风险。

结果

总体而言，在研究期间有2966例患者有锥切术，其中分别有567例（20％）和2399例（80％）患有激光锥切术和LEEP术。观察复发的预测因素，CIN3（HR：3.80（95％CI：2.01,7.21）; p <0.001）和HPV持续性（HR：1.81（95％CI：1.11,2.96）; p <0.001）的诊断与复发风险增加。应用PSM后，我们选择了500名接受激光锥切术的患者和1000名接受LEEP术的患者。与接受激光锥切术的患者相比，接受LEEP手术的患者手术切缘阳性的风险更高（分别为11.2％和4.2％）。两组之间持续存在HPV的风险相似（15.0％对11.6％；p = 0.256）。LEEP和激光锥切术后的五年复发率分别为8.1％和4％（p = 0.023）。HPV持续性是与激光锥切术（p = 0.003）和LEEP（p = 0.001）后[5-]年复发相关的唯一因素。