3 research outputs found
Factors predicting the outcome of conservately trated adenocarcinoma in situ of uterine cervix: an analysis of 166 cases
Objective. The present study assessed the clinical outcome of patients conservatively treated for cervical
adenocarcinoma in situ (AIS) and their predictive factors using univariate and multivariate population
averaged (PA) generalized estimating equation (GEE) model in a longitudinal setting.
Methods. A series of 166 consecutive women (mean age 39.8 yrs; range 23\u201363 yrs) underwent conservative
treatment of AIS as the primary treatment and were followed-up (mean 40.9 mo) using colposcopy, PAP-smear,
biopsy and HPV-testing with Hybrid Capture 2.
Results. Hysterectomy was performed as part of the primary management in 47 patients,who were excluded
from the follow-up (FU) analysis. Out of 119 women closely followed-up, additional therapeutic procedures
were performed in 69. At study conclusion, 7 patients (5.9%) showed persistent disease, while 8 (6.7%) had
progressed to invasive adenocarcinoma (AC). Positive HR-HPV test was the only independent predictor of
disease recurrence (adjusted OR=2.72; 95%CI 1.08\u20136.87), and together with free cone margins (OR=0.20;
95%CI 0.04\u20130.92), HR-HPV positivity was also the single most powerful predictor of disease progression to AC,
with OR=3.74; 95%CI 1.84\u20137.61 (p=0.0001) in multivariate PA-GEE.
Conclusions. These results suggest that testing HR-HPV positive at any time point during FU is the most
significant independent predictor of progressive disease, while showing free margins in cone has a significant
protective effect against progression to AC. Furthermore, because 4.3% women with persistent, recurrent or
progressive disease experienced a late (5th and 6th FU) diagnosis of HG-CGIN or microinvasive AC, a close
surveillance should be scheduled for at least three years in conservatively treated AIS patients