Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Abstract

Background: Cervical dysplasia persistence/recurrence has a great impact on women’s health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18–89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5–52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.

Isolated lymph nodal recurrence after 10 years in FIGO Stage IA1 cervical adenocarcinoma treated with conization: case report and review of the literature

“…Perhaps if our patient had undergone conization in the vaccination era, it could have reduced her recurrence risk. This is even more true when we look at the recent data regarding the risk of preneoplastic lesion recurrence: the persistence of HPV after FSS is the principal risk factor for recurrence [33] and HPV vaccination after FSS (conization) is associated with a reduce risk of CIN 2 recurrence [34].…”

Does Human Papillomavirus Infection Influence the Frequency and Severity of Nutritional Disorders in Head and Neck Cancer?

“…Cervical cancer is diagnosed in a significant percentage of women in developing countries. Importantly, the prognosis for patients with cervical dysplasia who receive appropriate treatment remains excellent [ 21 , 22 ]. Moreover, it is highlighted that HPV vaccination is the only efficacious method to reduce the risk of HPV−related cancer.…”

Advances on Prevention and Screening of Gynecologic Tumors: Are We Stepping Forward?

“…There are three approaches used to manage cancers, based on the concept of primary, secondary, and tertiary prevention. The primary prevention approach focuses on preventing disease before it develops (i.e., prophylactic treatment); secondary prevention attempts to detect the disease as early as possible (i.e., early detection); and tertiary prevention is directed at managing a present disease (i.e., treatment) [ 6 , 7 , 8 , 9 ].…”

“…Cross protection against other HPV types, not included in the vaccine, is shown only in vaccines that have the adjuvant substance 04 (AS04) [ 6 , 7 ]. Accumulating evidence suggests that the adoption of the vaccines resulted in a significant decrease in HPV infection, HPV lesions, and cervical cancer [ 6 , 7 , 8 , 9 ]. In particular, the most recent Cochrane systematic review about the topic clarified that both nonavalent and quadrivalent vaccines offer similar protection against a combined outcome of cervical, vaginal, and vulval precancer lesions or cancer [ 10 ].…”

“…New screening methods, such as p16/Ki67 [ 11 ], HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated [ 7 , 8 ]. It is useful to focus on precancerous lesions in order to create tools for women regarding their risk of persistence/recurrence after primary conization and identify categories at higher risk compared with the other ones [ 9 ]. Tertiary prevention in cervical cancer includes its treatment with surgery (radical hysterectomy), radiotherapy, and systemic treatments (chemotherapy, bevacizumab, and immunotherapy) [ 12 ].…”