Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization

Abstract

The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervical lesions. All patients included had both positive surgical margins and experienced HPV persistence at 6 months. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). The charts of 2966 patients undergoing conization were reviewed. Among the whole population, 163 (5.5%) patients met the inclusion criteria, being at high risk due to the presence of positive surgical margins and experiencing HPV persistence. Of 163 patients included, 17 (10.4%) patients developed a CIN2+ recurrence during the 5-year follow-up. Via univariate analyses, diagnosis of CIN3 instead of CIN2 (HR: 4.88 (95%CI: 1.10, 12.41); p = 0.035) and positive endocervical instead of ectocervical margins (HR: 6.44 (95%CI: 2.80, 9.65); p < 0.001) were associated with increased risk of persistence/recurrence. Via multivariate analyses, only positive endocervical instead of ectocervical margins (HR: 4.56 (95%CI: 1.23, 7.95); p = 0.021) were associated with worse outcomes. In this high-risk group, positive endocervical margins is the main risk factor predicting 5-year recurrence.

Duration of human papillomavirus persistence and its relationship with recurrent cervical dysplasia

“…Accumulating evidence has provided strong and consistent data that HPV persistence is the main factor influencing the risk of developing HPV-related disease, including cervical dysplasia and cervical cancer (Casarin et al ., 2020; Falcaro et al ., 2021; Mix et al ., 2022; Di Donato et al ., 2023; Giannini et al ., 2023). Duration of HPV persistence, viral load, deregulation of HPV gene expression, and host epigenetic mechanisms (including methylation of imprinted gene control) are the main factor influencing the process of tissue transformation (Smith et al ., 2022; Cicconi et al ., 2022; Demarco et al ., 2022; Mix et al ., 2022).…”

Cervical cancer screening and vaccination: knowledge, awareness, and attitude of female staff in a Nigerian University

“…This difference might be due to the lack of health education programs regarding cervical cancer vaccination in the urban slum, which is believed to be the problem of most developing countries [ 41 ]. Certain strategies have been suggested in literature including the use of nomograms in the sensitization of women [ 42 ] and also showing the women results of outcomes from women with cervical cancer as a way of making them realise why preventive behaviour is important [ 43 ]. The level of awareness and knowledge of cervical cancer, its aetiology, screening as well as HPV vaccination in women can greatly influence their participation in screening and vaccination programs [ 44 ].…”

Immunoinformatics applications in the development of therapeutic vaccines against human papillomavirus‐related infections and cervical cancer

“…22 Among these, types 16,18,31,33,35,39,45,51,52,56, and 58 are classified as high-risk types, while another six genotypes (26, 53, 66, 68, 73, and 82) are considered as probably high-risk types. HPV 6,11,40,42,43,44,54,61,70,72, and 81 are considered low-risk types associated with genital warts and low-grade CIN. 21 While genotypes 6 and 11 are associated with anogenital warts.…”

“…A recent study by Giannini et al (2023) 43 examined the effects of conization in women with high-grade cervical dysplasia, positive margins and HPV continuities. Findings revealed that although these have a higher risk of recurrence, they still have a similar overall survival rate compared to women without these risk factors.…”

“…However, more research is needed to determine the most effective management strategies for this high-risk group of women. 43 Beyond that, it is critical to remember that there is a disparity in access to HPV vaccines since countries with the highest burdens of HPV-related illnesses have the least access, and only approximately half of the countries have covered around one-third of the eligible population. 45,46 Affordability and financing of HPV vaccination are hurdles to uptake in low-and middle-income countries because of the comparably high vaccine cost and its delivery to the target public.…”