Objective To assess the long-term risk factors predicting residual/ recurrent cervical intraepithelial neoplasia (CIN 2-3) and time to recurrence after large loop excision of the transformation zone (LLETZ).Design Retrospective study. Setting Colposcopy clinic.Population 242 women with CIN 2-3 treated between 1996 and 2006 and followed up until June 2016.Methods Age, margins, and high-risk human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan-Meier analysis.Main outcome measure Histologically confirmed CIN 2-3, HR-HPV, margins, age.Results CIN 2-3 was associated with HR-HPV (HR = 30.5, 95% confidence interval [CI] = 3.80-246.20), age >35 years (HR = 5.53, 95% CI = 1.22-25.13), and margins (HR = 7.31, 95% CI = 1.60-33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto + /endocervical + (16.7%), uncertain (19.4%) and ecto À /endocervical + margins (9.1%) showed a higher risk of recurrence (odds ratio [OR] = 13.20, 95% CI = 1.02-170.96; OR = 15.84, 95% CI = 3.02-83.01; and OR = 6.60, 95% CI = 0.88-49.53, respectively). Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001).Conclusions HR-HPV and margins seem essential for stratifying post-LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women to reduce the risk.Keywords Cervical intraepithelial neoplasia, HPV, margin status, recurrence.Tweetable abstract After LLETZ for CIN 2-3, recurrences appear more often in women with positive HR-HPV and involved margins and aged over 35. Fern andez-Montol ı et al.

Abbreviations: ALND, axillary lymph node dissection; cN+, node-positive; DDFS, distant disease-free survival; DFS, disease-free survival; NACT, neo-adjuvant chemotherapy; OS, overall survival; pCR, pathologic complete response; SLNB, sentinel lymph node biopsy; ypN0, pathologic complete response in lymph nodes; ypT0, pathologic complete response in breast. AbstractA pathologic complete response (pCR) in the axilla occurs in 30%-40% of patients with initially node-positive breast cancer after neo-adjuvant chemotherapy (NACT). Debate persists about whether to perform systematic axillary lymphadenectomy (ALND) in patients with initial node-positive disease and clinical complete response after NACT. We aimed to identify predictive factors of axillary pCR (ypN0) after NACT. This retrospective study analyzed data for all patients with initial biopsy-proven node-positive disease who underwent ALND after NACT between June 2008 and December 2016 at our institution. Clinical and pathologic features, recurrence and specific mortality rates were compared between patients who achieved an axillary pCR and those who did not (ypN0 vs ypN+, respectively). A total of 331 patients were included, of whom 128 (38.7%) became ypN0 after NACT. Among patients with >2 suspicious axillary lymph nodes before treatment, 54 (38%) achieved ypN0 status. The independent predictors of ypN0 were Ki-67 > 30 (OR 1.98; 95% CI, 1.146-3.381), HER2 positivity (OR 2.6; 95% CI, 1.354-5.108), nonluminal molecular-like subtype (OR 4.15; 95% CI, 2.068-5.108), and clinical complete response, defined as negative clinical and ultrasonographic findings (OR 2.8; 95% CI, 1.110-7.081). After a mean follow-up of 61 months, distant disease-free and overall survival rates were higher in patients with ypN0 disease (HR 4.14; 95% CI, 2.03-8.43) than ypN+ patients. Complete clinical response and the presence of nonluminal molecular-like subtypes independently predicted ypN0. Patients meeting these criteria might be suitable form omitting ALND and just performing targeted axillary procedures to patients meeting these criteria. | 889FERNANDEZ-GONZALEZ Et AL. FERNANDEZ-GONZALEZ Et AL. AUTH O R CO NTR I B UTI O N SSergi Fernandez-Gonzalez involved in conceptualization, methodology, formal analysis, data curation,and writing of the manuscript.Catalina Falo and Amparo Garcia-Tejedor involved in conceptualization, methodology, writing, and supervision of the manuscript. Maria

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