J Gynecol Oncol.  2009 Jun;20(2):91-95. 10.3802/jgo.2009.20.2.91.

Factors associated with HPV persistence after conization in patients with negative margins

Affiliations
  • 1Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University, Bucheon, Korea. khnambc@yahoo.co.kr

Abstract


OBJECTIVE
The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins.
METHODS
We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used> or =1 relative light units (RLUs) as the cutoff for persistence of HPV after conization.
RESULTS
High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control >100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology.
CONCLUSION
Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.

Keyword

Conization; Negative margins; Persistent HPV infection; HPV type 16

MeSH Terms

Biopsy
Chimera
Conization
Follow-Up Studies
Human papillomavirus 16
Humans
Light
Logistic Models
Oligonucleotide Array Sequence Analysis
Retrospective Studies
Viral Load

Cited by  1 articles

Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment
Yung-Taek Ouh, Hyun Woong Cho, Seong Min Kim, Kyung-Jin Min, Sang-Hoon Lee, Jae-Yun Song, Jae-Kwan Lee, Nak Woo Lee, Jin Hwa Hong
Obstet Gynecol Sci. 2020;63(5):631-642.    doi: 10.5468/ogs.20049.


Reference

1. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999. 189:12–19.
2. von Keyserling H, Kaufmann AM, Schneider A. HPV testing in the follow-up after treatment of women with CIN. Gynecol Oncol. 2007. 107(1):Suppl 1. S5–S7.
3. McCredie MR, Sharples KJ, Paul C, Baranyai J, Medley G, Jones RW, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol. 2008. 9:425–434.
4. Pinto AP, Crum CP. Natural history of cervical neoplasia: defining progression and its consequence. Clin Obstet Gynecol. 2000. 43:352–362.
5. Prendiville W, Cullimore J, Norman S. Large loop excision of the transformation zone (LLETZ): a new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol. 1989. 96:1054–1060.
6. Lindeque BG. Management of cervical premalignant lesions. Best Pract Res Clin Obstet Gynaecol. 2005. 19:545–561.
7. Mitchell MF, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol. 1998. 92:737–744.
8. Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007. 8:985–993.
9. Soutter WP, Sasieni P, Panoskaltsis T. Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer. 2006. 118:2048–2055.
10. Soutter WP. Invasive cancer after treatment of cervical intraepithelial neoplasia. Ann Acad Med Singapore. 1998. 27:722–724.
11. Soutter WP, de Barros Lopes A, Fletcher A, Monaghan JM, Duncan ID, Paraskevaidis E, et al. Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. Lancet. 1997. 349:978–980.
12. Strander B, Andersson-Ellstrom A, Milsom I, Sparen P. Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study. BMJ. 2007. 335:1077.
13. Nuovo J, Melnikow J, Willan AR, Chan BK. Treatment outcomes for squamous intraepithelial lesions. Int J Gynaecol Obstet. 2000. 68:25–33.
14. Alonso I, Torne A, Puig-Tintore LM, Esteve R, Quinto L, Campo E, et al. Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3. Gynecol Oncol. 2006. 103:631–636.
15. Song SH, Lee JK, Oh MJ, Hur JY, Na JY, Park YK, et al. Persistent HPV infection after conization in patients with negative margins. Gynecol Oncol. 2006. 101:418–422.
16. Gok M, Coupe VM, Berkhof J, Verheijen RH, Helmerhorst TJ, Hogewoning CJ, et al. HPV 16 and increased risk of recurrence after treatment for CIN. Gynecol Oncol. 2007. 104:273–275.
17. Sarian LO, Derchain SF, Pitta Dda R, Morais SS, Rabelo-Santos SH. Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ). J Clin Virol. 2004. 31:270–274.
18. Costa S, De Simone P, Venturoli S, Cricca M, Zerbini ML, Musiani M, et al. Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization. Gynecol Oncol. 2003. 90:358–365.
19. Dalstein V, Riethmuller D, Pretet JL, Le Bail Carval K, Sautiere JL, Carbillet JP, et al. Persistence and load of high-risk HPV are predictors for development of high-grade cervical lesions: a longitudinal French cohort study. Int J Cancer. 2003. 106:396–403.
20. Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Desy M, et al. Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis. 1999. 180:1415–1423.
21. Park JY, Lee KH, Dong SM, Kang S, Park SY, Seo SS. The association of pre-conization high-risk HPV load and the persistence of HPV infection and persistence/recurrence of cervical intraepithelial neoplasia after conization. Gynecol Oncol. 2008. 108:549–554.
22. Bae JH, Kim CJ, Park TC, Namkoong SE, Park JS. Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure. Int J Gynecol Cancer. 2007. 17:1271–1277.
23. Kreimer AR, Katki HA, Schiffman M, Wheeler CM, Castle PE. Viral determinants of human papillomavirus persistence following loop electrical excision procedure treatment for cervical intraepithelial neoplasia grade 2 or 3. Cancer Epidemiol Biomarkers Prev. 2007. 16:1–6.
24. Kreimer AR, Guido RS, Solomon D, Schiffman M, Wacholder S, Jeronimo J, et al. Human papillomavirus testing following loop electrosurgical excision procedure identifies women at risk for posttreatment cervical intraepithelial neoplasia grade 2 or 3 disease. Cancer Epidemiol Biomarkers Prev. 2006. 15:908–914.
Full Text Links
  • JGO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr