Factors Associated With Recurrence of Cervical Intraepithelial Neoplasia 2+ After Treatment Among HIV-Infected Women in Western Kenya

Huchko, Megan J.; Leslie, Hannah H; Maloba, May; Bukusi, Elizabeth A.; Cohen, Craig R.

doi:10.1097/qai.0000000000000130

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Previous studies have mostly focused on analyzing the risk of recurrence in HIV‐infected women 16,17 . A study found that HIV‐positive patients with CIN2+ have an increased risk of recurrence (7.1%, 95% CI 4.4–10.7) 8 . In our study, women with comorbidities had a higher risk of recurrence, especially those with immunosuppression.…”

Section: Discussionmentioning

confidence: 45%

“…A few studies evaluate the risk of recurrence after LEEP for women with CIN2/3, but they report discordant results 6–10 . There is still uncertainty and debate as to which risk factors or combination of factors most accurately predict recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 A few studies evaluate the risk of recurrence after LEEP for women with CIN2/3, but they report discordant results. [6][7][8][9][10] There is still uncertainty and debate as to which risk factors or combination of factors most accurately predict recurrence. Most post-treatment surveillance reports were limited in follow-up duration, data quality, and study size.…”

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confidence: 99%

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Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia

Ding

Duan

et al. 2022

Intl J Gynecology & Obste

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Objective To evaluate the risk factors of recurrent high‐grade cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after loop electrosurgical excision procedure (LEEP). Methods This retrospective study included patients with histopathologically confirmed CIN2/3 who underwent LEEP in 2015–2020. Cox regression analysis was used to evaluate the risk factors of recurrence. Results Recurrent CIN2+ was found in 268 patients after LEEP (268/4369, recurrence rate, 6.1%). High‐risk (hr‐) HPV infection (hazard ratio [HR] 12.09, 95% confidence interval [CI] 7.78–18.79), margin status (HR 6.48, 95% CI 4.75–8.84), baseline diagnosis (HR 1.45, 95% CI 1.08–1.95), smoking (HR 3.17, 95% CI 2.27–4.43), and immunosuppression (HR 1.96, 95% CI 1.33–2.91) were significant independent risk factors of recurrence. HPV16 (HR 3.61, 95% CI 2.43–5.37), HPV33 (HR 2.62, 95% CI 1.12–6.12), and HPV52 (HR 1.61, 95% CI 1.02–2.55) infection showed a higher risk of recurrence. High‐risk HPV had the highest accuracy (sensitivity 88.5%; negative predictive values 98.7%) in predicting recurrence compared with liquid‐based cytology test and margins. Conclusion Given that positive margins present a higher risk, wide excision may be required to avoid residual lesions. More attention should be paid to the correlation between recurrence and hr‐HPV genotypes. After treatment for high‐grade CIN, HPV‐based testing is recommended at 6 months. Timely identification of high‐risk factors enables risk stratification, and enables individual management or individual follow‐up and recall strategies.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia

Ding

Duan

et al. 2022

Intl J Gynecology & Obste

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“…The largest proportion of articles was specific to conditions and outcomes of HIV+ women with CIN or cervical cancer, followed by an emphasis on feasibility considerations for providing treatment. HIV+ women were more likely to present with CIN or cervical cancer at an earlier age [ 240 ], have higher grade CIN [ 241 , 242 ], faster progression [ 243 ], more likely to experience CIN reoccurrence after treatment [ 236 ], and have poorer treatment and survival outcomes [ 238 , 243 , 244 ]. Antiretroviral therapy was shown to improve treatment outcomes for CIN and cervical cancer [ 245 – 248 ].…”

Section: Resultsmentioning

confidence: 99%

Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

et al. 2016

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BackgroundWomen living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.MethodsWe searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories.ResultsA total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts.ConclusionsCervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.

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“…Of note, literature concerning the association of complicating diseases with CIN recurrence after treatment primarily focused on areas with a high prevalence of HIV. [29][30][31] There was no obvious relationship between positive margins during loop excision and HIV-infection in a piece of research conducted in the region with low HIV-infection prevalence. [32] A meta-analysis conducted by Arbyn et al [33] to explore the association of incomplete excision with treatment failure did not discuss these complicating diseases.…”

Section: Discussionmentioning

confidence: 97%

Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization

Liu

Cheng

et al. 2021

Medicine

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This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization. Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data. After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases ( P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317–3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598–12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952–6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence. For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.

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Factors Associated With Recurrence of Cervical Intraepithelial Neoplasia 2+ After Treatment Among HIV-Infected Women in Western Kenya

Cited by 12 publications

References 23 publications

Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia

Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia

Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization

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