Prognostic outcomes and risk factors for recurrence after laser vaporization for cervical intraepithelial neoplasia: a single-center retrospective study.
Cervical intraepithelial neoplasia
Laser vaporization
Recurrence-free interval
Journal
International journal of clinical oncology
ISSN: 1437-7772
Titre abrégé: Int J Clin Oncol
Pays: Japan
ID NLM: 9616295
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
08
10
2020
accepted:
26
11
2020
pubmed:
5
1
2021
medline:
24
3
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Cervical intraepithelial neoplasia (CIN) is a precancerous lesion that may progress to invasive cervical cancer without intervention. We aim to examine the prognostic outcomes and risk factors for recurrence after laser vaporization for CIN 3, CIN 2 with high-risk human papillomavirus (HPV) infection, and CIN 1 persisting for more than 2 years. Between 2008 and 2016, a total of 1070 patients underwent cervical laser vaporization using a carbon dioxide laser. We performed a retrospective review of their medical records to assess their clinical characteristics, pathologic factors, and prognostic outcomes. The mean patient age was 34 years (range 18-64 years). The preoperative diagnosis was CIN 1 in 27 patients, CIN 2 in 485 patients, and CIN 3 in 558 patients. Over a median follow-up period of 15 months, the 2-year recurrence rate was 18.9%, and the 5-year recurrence rate was 46.5%. The 2-year retreatment rate was 12.6%, and the 5-year retreatment rate was 30.5%. We diagnosed 9 patients with invasive cancer after treatment; all patients underwent combined multidisciplinary treatment, and there were no deaths during follow-up. The recurrence-free interval was correlated with patient age (hazard ratio [HR], 1.028; 95% CI 1.005-1.051; P = 0.0167), body mass index (HR, 1.052; 95% CI 1.008-1.098; P = 0.0191), and glandular involvement (HR, 1.962; 95% CI 1.353-2.846; P = 0.0004). Cervical laser vaporization is effective and useful for patients with CIN who wish to preserve fertility. However, patients with glandular involvement, older age, and higher body weight require close follow-up for recurrence.
Sections du résumé
BACKGROUND
BACKGROUND
Cervical intraepithelial neoplasia (CIN) is a precancerous lesion that may progress to invasive cervical cancer without intervention. We aim to examine the prognostic outcomes and risk factors for recurrence after laser vaporization for CIN 3, CIN 2 with high-risk human papillomavirus (HPV) infection, and CIN 1 persisting for more than 2 years.
METHODS
METHODS
Between 2008 and 2016, a total of 1070 patients underwent cervical laser vaporization using a carbon dioxide laser. We performed a retrospective review of their medical records to assess their clinical characteristics, pathologic factors, and prognostic outcomes.
RESULTS
RESULTS
The mean patient age was 34 years (range 18-64 years). The preoperative diagnosis was CIN 1 in 27 patients, CIN 2 in 485 patients, and CIN 3 in 558 patients. Over a median follow-up period of 15 months, the 2-year recurrence rate was 18.9%, and the 5-year recurrence rate was 46.5%. The 2-year retreatment rate was 12.6%, and the 5-year retreatment rate was 30.5%. We diagnosed 9 patients with invasive cancer after treatment; all patients underwent combined multidisciplinary treatment, and there were no deaths during follow-up. The recurrence-free interval was correlated with patient age (hazard ratio [HR], 1.028; 95% CI 1.005-1.051; P = 0.0167), body mass index (HR, 1.052; 95% CI 1.008-1.098; P = 0.0191), and glandular involvement (HR, 1.962; 95% CI 1.353-2.846; P = 0.0004).
CONCLUSIONS
CONCLUSIONS
Cervical laser vaporization is effective and useful for patients with CIN who wish to preserve fertility. However, patients with glandular involvement, older age, and higher body weight require close follow-up for recurrence.
Identifiants
pubmed: 33394202
doi: 10.1007/s10147-020-01848-x
pii: 10.1007/s10147-020-01848-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
770-776Subventions
Organisme : Japan Society for the Promotion of Science London
ID : JP19K09804
Références
Parkin DM, Bray F, Ferlay J et al (2002) (2005) Global cancer statistics. CA Cancer J Clin 55(2):74–108. https://doi.org/10.3322/canjclin.55.2.74
doi: 10.3322/canjclin.55.2.74
International Agency for Research on Cancer Multicenter Cervical Cancer Study G, Munoz N, Bosch FX, de Sanjose S et al (2003) Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 348(6):518–527. https://doi.org/10.1056/NEJMoa021641
doi: 10.1056/NEJMoa021641
Brianti P, De Flammineis E, Mercuri SR (2017) Review of HPV-related diseases and cancers. New Microbiol 40(2):80–85
pubmed: 28368072
Ostör AG (1993) Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 12(2):186–192
doi: 10.1097/00004347-199304000-00018
Ginsburg O, Bray F, Coleman MP et al (2017) The global burden of women’s cancers: a grand challenge in global health. The Lancet 389(10071):847–860. https://doi.org/10.1016/s0140-6736(16)31392-7
doi: 10.1016/s0140-6736(16)31392-7
Sawaya GF, Smith-McCune K, Kuppermann M (2019) Cervical cancer screening: more choices in 2019. JAMA 321(20):2018–2019. https://doi.org/10.1001/jama.2019.4595
doi: 10.1001/jama.2019.4595
pubmed: 31135834
pmcid: 6656358
Kocken M, Helmerhorst TJM, Berkhof J et al (2011) Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study. Lancet Oncol 12(5):441–450. https://doi.org/10.1016/s1470-2045(11)70078-x
doi: 10.1016/s1470-2045(11)70078-x
pubmed: 21530398
Sadler L, Saftlas A, Wang W et al (2004) Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 291(17):2100–2106. https://doi.org/10.1001/jama.291.17.2100
doi: 10.1001/jama.291.17.2100
pubmed: 15126438
Kyrgiou M, Koliopoulos G, Martin-Hirsch P et al (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 367(9509):489–498. https://doi.org/10.1016/s0140-6736(06)68181-6
doi: 10.1016/s0140-6736(06)68181-6
pubmed: 16473126
Mathevet P, Chemali E, Roy M et al (2003) Long-term outcome of a randomized study comparing three techniques of conization: cold knife, laser, and LEEP. Eur J Obstet Gynecol Reprod Biol 106(2):214–218. https://doi.org/10.1016/s0301-2115(02)00245-2
doi: 10.1016/s0301-2115(02)00245-2
pubmed: 12551795
Anderson MC, Hartley RB (1979) Cervical crypt involvement by intraepithelial neoplasia. Obstet Gynecol Surv 34(11):852–853. https://doi.org/10.1097/00006254-197911000-00031
doi: 10.1097/00006254-197911000-00031
pubmed: 523037
Jordan JA, Woodman CB, Mylotte MJ et al (1985) The treatment of cervical intraepithelial neoplasia by laser vaporization. Br J Obstet Gynaecol 92(4):394–398. https://doi.org/10.1111/j.1471-0528.1985.tb01114.x
doi: 10.1111/j.1471-0528.1985.tb01114.x
pubmed: 3986168
Partington CK, Turner MJ, Soutter WP et al (1989) Laser vaporization versus laser excision conization in the treatment of cervical intraepithelial neoplasia. Obstet Gynecol 73:775–779
pubmed: 2649822
Alvarez RD, Helm CW, Edwards RP et al (1994) Prospective randomized trial of LLETZ versus laser ablation in patients with cervical intraepithelial neoplasia. Gynecol Oncol 52(2):175–179. https://doi.org/10.1006/gyno.1994.1027
doi: 10.1006/gyno.1994.1027
pubmed: 8314135
Dey P, Gibbs A, Arnold DF et al (2002) Loop diathermy excision compared with cervical laser vaporisation for the treatment of intraepithelial neoplasia: a randomised controlled trial. BJOG 109(4):381–385. https://doi.org/10.1111/j.1471-0528.2002.01277.x
doi: 10.1111/j.1471-0528.2002.01277.x
pubmed: 12013158
Mariya T, Nishikawa A, Sogawa K et al (2016) Virological and cytological clearance in laser vaporization and conization for cervical intra-epithelial neoplasia grade 3. J Obstet Gynaecol Res 42(12):1808–1813. https://doi.org/10.1111/jog.13113
doi: 10.1111/jog.13113
pubmed: 27526956
Inaba K, Nagasaka K, Kawana K et al (2014) High-risk human papillomavirus correlates with recurrence after laser ablation for treatment of patients with cervical intraepithelial neoplasia 3: a long-term follow-up retrospective study. J Obstet Gynaecol Res 40(2):554–560. https://doi.org/10.1111/jog.12196
doi: 10.1111/jog.12196
pubmed: 24118526
Stentella P, Pace S, Villani C et al (1995) Cervical intraepithelial neoplasia: carbon dioxide laser vaporization and conization. Our Exp Eur J Gynaecol Oncol 16(4):282–289
Soutter WP, de Barros LA, Fletcher A et al (1997) Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. Lancet 349(9057):978–980. https://doi.org/10.1016/s0140-6736(96)08295-5
doi: 10.1016/s0140-6736(96)08295-5
pubmed: 9100623
Soutter WP, Sasieni P, Panoskaltsis T (2006) Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer 118(8):2048–2055. https://doi.org/10.1002/ijc.21604
doi: 10.1002/ijc.21604
pubmed: 16284947
Chew GK, Jandial L, Paraskevaidis E et al (1999) Pattern of CIN recurrence following laser ablation treatment: long-term follow-up. Int J Gynecol Cancer 9(6):487–490. https://doi.org/10.1046/j.1525-1438.1999.99066.x
doi: 10.1046/j.1525-1438.1999.99066.x
pubmed: 11240816
Persad VL, Pierotic MA, Guijon FB (2001) Management of cervical neoplasia: a 13-year experience with cryotherapy and laser. J Low Genit Tract Dis 5(4):199–203. https://doi.org/10.1046/j.1526-0976.2001.54002.x
doi: 10.1046/j.1526-0976.2001.54002.x
pubmed: 17050975
Chen JY, Wang ZL, Wang ZY et al (2018) The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization. Medicine (Baltimore) 97(41):e12792. https://doi.org/10.1097/MD.0000000000012792
doi: 10.1097/MD.0000000000012792
Melnikow J, McGahan C, Sawaya GF et al (2009) Cervical intraepithelial neoplasia outcomes after treatment: long-term follow-up from the British Columbia Cohort Study. J Natl Cancer Inst 101(10):721–728. https://doi.org/10.1093/jnci/djp089
doi: 10.1093/jnci/djp089
pubmed: 19436026
pmcid: 2684554
Bogani G, Cromi A, Serati M et al (2015) Laparoscopic and vaginal approaches to hysterectomy in the obese. Eur J Obstet Gynecol Reprod Biol 189:85–90. https://doi.org/10.1016/j.ejogrb.2015.02.035
doi: 10.1016/j.ejogrb.2015.02.035
pubmed: 25898369
Byun JM, Jeong DH, Kim YN et al (2018) Persistent HPV-16 infection leads to recurrence of high-grade cervical intraepithelial neoplasia. Medicine (Baltimore) 97(51):e13606. https://doi.org/10.1097/MD.0000000000013606
doi: 10.1097/MD.0000000000013606