Predictive factors for persistent and recurrent cervical dysplasia after loop electrosurgical excision procedure in postmenopausal women

Abstract

The aim of this study was to prospectively evaluate the outcomes of conservative treatment for pathological proven CIN2/3 (cervical intraepithelial neoplasia) in postmenopausal women and the risk factors potentially involved in the persistence/recurrence of cervical dysplasia. A prospective cohort study was performed over an 18-months period on 132 post-climax women with CIN2/3 treated by loop electrosurgical excision procedure (LEEP) attending follow-up visits. We assessed the relationship between age, parity, AFSI (age at first sexual intercourse), smoking status, use of oral contraceptives, high-risk human papillomavirus (HR-HPV) status, surgical margins, glandular involvement and risk of persistent/recurrent disease. Unadjusted and adjusted analyses were performed. Residual/recurrent disease was proved by colposcopically guided biopsy in 25 patients (18.9%). On a multivariate logistic regression analysis, age>50 years (OR 4.85 95%CI 1.09-21.53, p<0.0001), positive surgical margins (OR 4.26, 95% CI 1.64-11.04, p<0.001) and HR - HPV persistence (OR 5.73, 95% CI 1.93-16.97, p<0.001) were statistically predictive for persistent/recurrent lesions. The most important predictive factors for persistent/recurrent disease in postmenopause women treated conservatively for CIN2/3 are advanced age, positive surgical margins and HR-HPV post treatment persistence; the combined evaluation of these three factors allows placing patients with LEEP into different categories at risk, thus requiring special attention with a rigorous follow -up protocol and preventing a primarily radical therapeutic approach in this particular age - group.