Risk Factors for Persistence or Recurrence of High-Grade Cervical Squamous Intraepithelial Lesions

Abstract

Objectives: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence of the lesion. Methods: a cross-sectional, observational, retrospective study of patients submitted to cold knife conization (CKC) or the loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2 or 3. The colposcopic lesion size, age, surgical method, involvement of the surgical margins, and p16/Ki-67 immunomarker expression were analyzed in relation to lesion persistence and recurrence. Results: seventy-one women were treated with cold knife conization and 200 were treated with loop electrosurgical excision. Of these, 95 had cervical intraepithelial neoplasia 2, 173 had cervical intraepithelial neoplasia 3, 183 had free surgical margins, 76 had compromised margins, and 12 showed damage by processing artifact or fragments. Among the 76 cases with positive margins, 55, 11, and 10 showed endocervical margin involvement, ectocervical margin involvement, and both endocervial and ectocervical margin involvement, respectively. Of the 264 followed-up patients, 38 had persistent or recurrent disease. A multiple logistic regression indicated that positive endocervical margins are the only independent risk factor for the persistence/recurrence of cervical intraepithelial neoplasia. No significant association was identified between the colposcopic lesion size, age, surgery type, or p16/Ki-67 immunomarker expression and lesion persistence or recurrence.

Differential Analysis of Pregnancy Outcomes After Treatment of HIFU and LEEP in Patients with Cervical High-Grade Squamous Intraepithelial Lesions

“…Some research suggests that persistence of HPV infection and positive endocervical margins are risk factors for the persistence or recurrence of CIN, and there is no significant association with the type of therapy. 24 , 25 As mentioned before, the indications for HIFU therapy are strictly controlled, it is not suitable for cervical HSIL patients with ECC-positive biopsy and type 2 or 3 transformation zone, who should adopt more active treatment, and the conization depth should be properly increased to prevent positive postoperative margins. 26 …”

Faktor Risiko Kekambuhan Lesi Prakanker Serviks Pasca Pengobatan Tinjauan Literatur

“…• Faktor risiko kekambuhan yaitu perempuan dengan hasil margin positif atau uncertain (HR= 2,67; 95% CI=1,81 -3,93) (Alder et al, 2020), perempuan yang memiliki komorbid (HR= 2,23; 95% CI=1,36 -3,66) (Alder et al, 2020) (Ding et al, 2023) • Recurrent rate lesi prakanker serviks sebesar 6,1%. (Bittencourt et al, 2023) • Sebesar 14,3% dari 264 pasien yang diamati menderita kekambuhan lesi prakanker serviks. (Zeng et al, 2022) • Sebesar 14,1% dari 740 perempuan yang diamati menderita kekambuhan.…”

“…Hal tersebut didasari atas fakta bahwa lesi prakanker serviks yang telah ditangani dapat muncul kembali atau disebut dengan kekambuhan. Berdasarkan keseluruhan literatur yang ditinjau, diketahui bahwa tingkat kekambuhan atau recurrence rate lesi prakanker serviks berkisar antara 6,1% hingga 21,69% (Alder et al, 2020;Belkić et al, 2022;Bittencourt et al, 2023;Bogale et al, 2022;Ding et al, 2023;Ge et al, 2021;Kulkarni et al, 2023;Pambinkavil et al, 2023;Zeng et al, 2022). Lebih dari 50% kekambuhan terjadi kurang dari dua tahun pasca pengobatan lesi prakanker serviks (Fernández-Montolí et al, 2020).…”