Giorgio Bogani1, Violante DI Donato2, Francesco Sopracordevole3, Andrea Ciavattini4, Alessandro Ghelardi5, Salvatore Lopez6, Tommaso Simoncini7, Francesco Plotti8, Jvan Casarin9, Maurizio Serati9, Ciro Pinelli10, Gaetano Valenti3, Alice Bergamini11, Barbara Gardella12, Andrea Dell'acqua13, Ermelinda Monti13, Paolo Vercellini13, Margherita Fischetti2, Giovanni D'Ippolito14, Lorenzo Aguzzoli14, Vincenzo D Mandato14, Paola Carunchio14, Gabriele Carlinfante14, Luca Giannella4, Cono Scaffa15, Francesca Falcone15, Chiara Borghi16, Antonino Ditto6, Mario Malzoni17, Andrea Giannini18, Maria Giovanna Salerno18, Viola Liberale19, Biagio Contino19, Cristina Donfrancesco20, Michele Desiato20, Anna Myriam Perrone21, Giulia Dondi21, Pierandrea De Iaco21, Umberto Leone Roberti Maggiore6, Mauro Signorelli6, Valentina Chiappa6, Simone Ferrero22, Giuseppe Sarpietro23, Maria G Matarazzo23, Antonio Cianci23, Sara Bosio24, Simona Ruisi24, Rocco Guerrisi10, Claudia Brusadelli10, Lavinia Mosca25, Raffaele Tinelli26, Rosa DE Vincenzo27, Gian Franco Zannoni27, Gabriella Ferrandina27, Marco Petrillo28, Salvatore Dessole28, Roberto Angioli8, Stefano Greggi15, Arsenio Spinillo12, Fabio Ghezzi29, Nicola Colacurci25, Ludovico Muzii2, Pierluigi Benedetti Panici2, Giovanni Scambia27, Francesco Raspagliesi6. 1. Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy. Electronic address: giorgio.bogani@istitutotumori.mi.it. 2. Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy. 3. Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy. 4. Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy. 5. Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy. 6. Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy. 7. Department of Clinical and Experimental Medicine, University of Pisa, Italy. 8. Campus Bio-Medico University of Rome, Italy. 9. Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy. 10. Ospedale di circolo Fondazione Macchi, Varese, Italy. 11. Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy. 12. IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy. 13. Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 14. Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy. 15. Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy. 16. Department of Obstetrics and Gynecology, S. Anna University Hospital, Ferrara, Italy. 17. Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. 18. Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy. 19. Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy. 20. Department of Obstetrics and Gynecology, Azienda ASL, Frosinone, Ospedale S Trinità di Sora, Sora, Iatly. 21. Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy. 22. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy. 23. Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124, Catania, Italy. 24. San Paolo Hospital, Università degli Studi di Milano, 20142, Milan, Italy. 25. Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy. 26. Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, via San Francesco da Paola, 74015, Taranto, Italy. 27. UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 28. Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. 29. Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy; Ospedale di circolo Fondazione Macchi, Varese, Italy.
Abstract
OBJECTIVE: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.
OBJECTIVE: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.
Authors: Giorgio Bogani; Luca Lalli; Francesco Sopracordevole; Andrea Ciavattini; Alessandro Ghelardi; Tommaso Simoncini; Francesco Plotti; Jvan Casarin; Maurizio Serati; Ciro Pinelli; Alice Bergamini; Barbara Gardella; Andrea Dell'Acqua; Ermelinda Monti; Paolo Vercellini; Innocenza Palaia; Giorgia Perniola; Margherita Fischetti; Giusi Santangelo; Alice Fracassi; Giovanni D'Ippolito; Lorenzo Aguzzoli; Vincenzo Dario Mandato; Luca Giannella; Cono Scaffa; Francesca Falcone; Chiara Borghi; Mario Malzoni; Andrea Giannini; Maria Giovanna Salerno; Viola Liberale; Biagio Contino; Cristina Donfrancesco; Michele Desiato; Anna Myriam Perrone; Giulia Dondi; Pierandrea De Iaco; Simone Ferrero; Giuseppe Sarpietro; Maria G Matarazzo; Antonio Cianci; Stefano Cianci; Sara Bosio; Simona Ruisi; Lavinia Mosca; Raffaele Tinelli; Rosa De Vincenzo; Gian Franco Zannoni; Gabriella Ferrandina; Marco Petrillo; Giampiero Capobianco; Salvatore Dessiole; Annunziata Carlea; Fulvio Zullo; Barbara Muschiato; Stefano Palomba; Stefano Greggi; Arsenio Spinillo; Fabio Ghezzi; Nicola Colacurci; Roberto Angioli; Pierluigi Benedetti Panici; Ludovico Muzii; Giovanni Scambia; Francesco Raspagliesi; Violante Di Donato Journal: Vaccines (Basel) Date: 2022-04-09
Authors: Nae Ry Kim; Zee Hae Baek; A Jin Lee; Eun Jung Yang; Yung-Taek Ouh; Mi Kyung Kim; Seung-Hyuk Shim; Sun Joo Lee; Tae Jin Kim; Kyeong A So Journal: J Clin Med Date: 2022-05-25 Impact factor: 4.964
Authors: Violante Di Donato; Giuseppe Caruso; Giorgio Bogani; Eugenio Nelson Cavallari; Gaspare Palaia; Giorgia Perniola; Massimo Ralli; Sara Sorrenti; Umberto Romeo; Angelina Pernazza; Alessandra Pierangeli; Ilaria Clementi; Andrea Mingoli; Andrea Cassoni; Federica Tanzi; Ilaria Cuccu; Nadia Recine; Pasquale Mancino; Marco de Vincentiis; Valentino Valentini; Gabriella d'Ettorre; Carlo Della Rocca; Claudio Maria Mastroianni; Guido Antonelli; Antonella Polimeni; Ludovico Muzii; Innocenza Palaia Journal: Vaccines (Basel) Date: 2022-02-04