Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

Giorgio Bogani; Violante Di Donato; Francesco Sopracordevole; Andrea Ciavattini; Alessandro Ghelardi; Salvatore Lopez; Tommaso Simoncini; Francesco Plotti; Jvan Casarin; Maurizio Serati; Ciro Pinelli; Gaetano Valenti; Alice Bergamini; Barbara Gardella; Andrea Dell'Acqua; Ermelinda Monti; Paolo Vercellini; Margherita Fischetti; Giovanni D'Ippolito; Lorenzo Aguzzoli; Vincenzo D. Mandato; Paola Carunchio; Gabriele Carlinfante; Luca Giannella; Cono Scaffa; Francesca Falcone; Chiara Borghi; Antonino Ditto; Mario Malzoni; Andrea Giannini; Maria Giovanna Salerno; Viola Liberale; Biagio Contino; Cristina Donfrancesco; Michele Desiato; Anna Myriam Perrone; Giulia Dondi; Pierandrea De Iaco; Umberto Leone Roberti Maggiore; Mauro Signorelli; Valentina Chiappa; Simone Ferrero; Giuseppe Sarpietro; Maria G. Matarazzo; Antonio Cianci; Sara Bosio; Simona Ruisi; Rocco Guerrisi; Claudia Brusadelli; Lavinia Mosca; Raffaele Tinelli; Rosa Pasqualina De Vincenzo; Gian Franco Zannoni; Maria Gabriella Ferrandina; Marco Petrillo; Salvatore Dessole; Roberto Angioli; Stefano Greggi; Arsenio Spinillo; Fabio Ghezzi; Nicola Colacurci; Ludovico Muzii; Pierluigi Benedetti Panici; Giovanni Scambia; Francesco Raspagliesi

doi:10.1016/j.ygyno.2020.08.025

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

Giorgio Bogani, Violante Di Donato, Francesco Sopracordevole, Andrea Ciavattini, Alessandro Ghelardi, Salvatore Lopez, Tommaso Simoncini, Francesco Plotti, Jvan Casarin, Maurizio Serati, Ciro Pinelli, Gaetano Valenti, Alice Bergamini, Barbara Gardella, Andrea Dell'Acqua, Ermelinda Monti, Paolo Vercellini, Margherita Fischetti, Giovanni D'Ippolito, Lorenzo AguzzoliVincenzo D. Mandato, Paola Carunchio, Gabriele Carlinfante, Luca Giannella, Cono Scaffa, Francesca Falcone, Chiara Borghi, Antonino Ditto, Mario Malzoni, Andrea Giannini, Maria Giovanna Salerno, Viola Liberale, Biagio Contino, Cristina Donfrancesco, Michele Desiato, Anna Myriam Perrone, Giulia Dondi, Pierandrea De Iaco, Umberto Leone Roberti Maggiore, Mauro Signorelli, Valentina Chiappa, Simone Ferrero, Giuseppe Sarpietro, Maria G. Matarazzo, Antonio Cianci, Sara Bosio, Simona Ruisi, Rocco Guerrisi, Claudia Brusadelli, Lavinia Mosca, Raffaele Tinelli, Rosa Pasqualina De Vincenzo, Gian Franco Zannoni, Maria Gabriella Ferrandina, Marco Petrillo, Salvatore Dessole, Roberto Angioli, Stefano Greggi, Arsenio Spinillo, Fabio Ghezzi, Nicola Colacurci, Ludovico Muzii, Pierluigi Benedetti Panici, Giovanni Scambia, Francesco Raspagliesi

Risultato della ricerca: Contributo in rivista › Articolo in rivista

5 Citazioni (Scopus)

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.

Lingua originale	English
pagine (da-a)	N/A-N/A
Rivista	Gynecologic Oncology
DOI	https://doi.org/10.1016/j.ygyno.2020.08.025
Stato di pubblicazione	Pubblicato - 2020

Keywords

Cervical dysplasia
Conization
HPV
LEEP
Laser conization

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10.1016/j.ygyno.2020.08.025

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Bogani, G., Di Donato, V., Sopracordevole, F., Ciavattini, A., Ghelardi, A., Lopez, S., Simoncini, T., Plotti, F., Casarin, J., Serati, M., Pinelli, C., Valenti, G., Bergamini, A., Gardella, B., Dell'Acqua, A., Monti, E., Vercellini, P., Fischetti, M., D'Ippolito, G., ... Raspagliesi, F. (2020). Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study. Gynecologic Oncology, N/A-N/A. https://doi.org/10.1016/j.ygyno.2020.08.025

@article{93c0b4910f86463eabc26eade37c39ba,

title = "Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study",

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.",

keywords = "Cervical dysplasia, Conization, HPV, LEEP, Laser conization, Cervical dysplasia, Conization, HPV, LEEP, Laser conization",

author = "Giorgio Bogani and {Di Donato}, Violante and Francesco Sopracordevole and Andrea Ciavattini and Alessandro Ghelardi and Salvatore Lopez and Tommaso Simoncini and Francesco Plotti and Jvan Casarin and Maurizio Serati and Ciro Pinelli and Gaetano Valenti and Alice Bergamini and Barbara Gardella and Andrea Dell'Acqua and Ermelinda Monti and Paolo Vercellini and Margherita Fischetti and Giovanni D'Ippolito and Lorenzo Aguzzoli and Mandato, {Vincenzo D.} and Paola Carunchio and Gabriele Carlinfante and Luca Giannella and Cono Scaffa and Francesca Falcone and Chiara Borghi and Antonino Ditto and Mario Malzoni and Andrea Giannini and Salerno, {Maria Giovanna} and Viola Liberale and Biagio Contino and Cristina Donfrancesco and Michele Desiato and Perrone, {Anna Myriam} and Giulia Dondi and {De Iaco}, Pierandrea and {Leone Roberti Maggiore}, Umberto and Mauro Signorelli and Valentina Chiappa and Simone Ferrero and Giuseppe Sarpietro and Matarazzo, {Maria G.} and Antonio Cianci and Sara Bosio and Simona Ruisi and Rocco Guerrisi and Claudia Brusadelli and Lavinia Mosca and Raffaele Tinelli and {De Vincenzo}, {Rosa Pasqualina} and Zannoni, {Gian Franco} and Ferrandina, {Maria Gabriella} and Marco Petrillo and Salvatore Dessole and Roberto Angioli and Stefano Greggi and Arsenio Spinillo and Fabio Ghezzi and Nicola Colacurci and Ludovico Muzii and {Benedetti Panici}, Pierluigi and Giovanni Scambia and Francesco Raspagliesi",

year = "2020",

doi = "10.1016/j.ygyno.2020.08.025",

language = "English",

pages = "N/A--N/A",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Orlando, Fla. : Academic Press",

}

Bogani, G, Di Donato, V, Sopracordevole, F, Ciavattini, A, Ghelardi, A, Lopez, S, Simoncini, T, Plotti, F, Casarin, J, Serati, M, Pinelli, C, Valenti, G, Bergamini, A, Gardella, B, Dell'Acqua, A, Monti, E, Vercellini, P, Fischetti, M, D'Ippolito, G, Aguzzoli, L, Mandato, VD, Carunchio, P, Carlinfante, G, Giannella, L, Scaffa, C, Falcone, F, Borghi, C, Ditto, A, Malzoni, M, Giannini, A, Salerno, MG, Liberale, V, Contino, B, Donfrancesco, C, Desiato, M, Perrone, AM, Dondi, G, De Iaco, P, Leone Roberti Maggiore, U, Signorelli, M, Chiappa, V, Ferrero, S, Sarpietro, G, Matarazzo, MG, Cianci, A, Bosio, S, Ruisi, S, Guerrisi, R, Brusadelli, C, Mosca, L, Tinelli, R, De Vincenzo, RP , Zannoni, GF , Ferrandina, MG, Petrillo, M, Dessole, S, Angioli, R, Greggi, S, Spinillo, A, Ghezzi, F, Colacurci, N, Muzii, L, Benedetti Panici, P, Scambia, G & Raspagliesi, F 2020, 'Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study', Gynecologic Oncology, pagg. N/A-N/A. https://doi.org/10.1016/j.ygyno.2020.08.025

TY - JOUR

T1 - Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

AU - Bogani, Giorgio

AU - Di Donato, Violante

AU - Sopracordevole, Francesco

AU - Ciavattini, Andrea

AU - Ghelardi, Alessandro

AU - Lopez, Salvatore

AU - Simoncini, Tommaso

AU - Plotti, Francesco

AU - Casarin, Jvan

AU - Serati, Maurizio

AU - Pinelli, Ciro

AU - Valenti, Gaetano

AU - Bergamini, Alice

AU - Gardella, Barbara

AU - Dell'Acqua, Andrea

AU - Monti, Ermelinda

AU - Vercellini, Paolo

AU - Fischetti, Margherita

AU - D'Ippolito, Giovanni

AU - Aguzzoli, Lorenzo

AU - Mandato, Vincenzo D.

AU - Carunchio, Paola

AU - Carlinfante, Gabriele

AU - Giannella, Luca

AU - Scaffa, Cono

AU - Falcone, Francesca

AU - Borghi, Chiara

AU - Ditto, Antonino

AU - Malzoni, Mario

AU - Giannini, Andrea

AU - Salerno, Maria Giovanna

AU - Liberale, Viola

AU - Contino, Biagio

AU - Donfrancesco, Cristina

AU - Desiato, Michele

AU - Perrone, Anna Myriam

AU - Dondi, Giulia

AU - De Iaco, Pierandrea

AU - Leone Roberti Maggiore, Umberto

AU - Signorelli, Mauro

AU - Chiappa, Valentina

AU - Ferrero, Simone

AU - Sarpietro, Giuseppe

AU - Matarazzo, Maria G.

AU - Cianci, Antonio

AU - Bosio, Sara

AU - Ruisi, Simona

AU - Guerrisi, Rocco

AU - Brusadelli, Claudia

AU - Mosca, Lavinia

AU - Tinelli, Raffaele

AU - De Vincenzo, Rosa Pasqualina

AU - Zannoni, Gian Franco

AU - Ferrandina, Maria Gabriella

AU - Petrillo, Marco

AU - Dessole, Salvatore

AU - Angioli, Roberto

AU - Greggi, Stefano

AU - Spinillo, Arsenio

AU - Ghezzi, Fabio

AU - Colacurci, Nicola

AU - Muzii, Ludovico

AU - Benedetti Panici, Pierluigi

AU - Scambia, Giovanni

AU - Raspagliesi, Francesco

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - Cervical dysplasia

KW - Conization

KW - HPV

KW - LEEP

KW - Laser conization

KW - Cervical dysplasia

KW - Conization

KW - HPV

KW - LEEP

KW - Laser conization

UR - http://hdl.handle.net/10807/160902

U2 - 10.1016/j.ygyno.2020.08.025

DO - 10.1016/j.ygyno.2020.08.025

M3 - Article

SN - 0090-8258

SP - N/A-N/A

JO - Gynecologic Oncology

JF - Gynecologic Oncology

ER -

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

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Keywords

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