Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up

Author(s)

Andrade, Carlos E. M. C. ^[1] ; Scapulatempo-Neto, Cristovam ^[1] ; Longatto-Filho, Adhemar ^[1] ; Vieira, Marcelo A. ^[1] ; Tsunoda, Audrey T. ^[1] ; da Silva, Ismael D. C. G. ^[2] ; Fregnani, Jose Humberto T. G. ^[1]

Affiliation

^[1] Barretos Canc Hosp Pio XII Fdn, Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo UNIFESP, Sao Paulo - Brazil

• Document type: Journal article
• Source: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA; v. 93, n. 9, p. 941-948, SEP 2014.
• Web of Science Citations: 4

Abstract

Objective. To develop a prognostic model for women who underwent surgical treatment for cervical intraepithelial neoplasia. Design. Cohort study. Patient inclusion and follow-up occurred retrospectively and prospectively. Setting. Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil. Population. Women (n = 242) diagnosed with cervical intraepithelial neoplasia who were submitted to conization. Methods. Immediately prior to surgical treatment, a cervical cytology sample was collected from each individual included in the study by endocervical brushing and stored in a preservative solution with methanol. A human papilloma virus-DNA test was conducted using an aliquot of the endocervical brushings. The surgical specimens were subjected to immunohistochemical analysis of p16 (immunohistochemical analysis 4a) protein expression. Main outcome measures. Two-year disease-free survival rates calculated for each study variable. Identified variables in the multivariate Cox model were used for elaboration of prognostic scores. Results. Variables associated with outcome included age (p = 0.033), tobacco use (p < 0.001), final histopathological diagnosis (p = 0.007), surgical margins (p < 0.001), high-risk human papilloma virus status (p = 0.008), human papilloma virus-16 status (p < 0.001) and immunoexpression of p16 in the cytoplasm (p = 0.049). By the Cox model, independent risk factors for disease recurrence/persistence were: tobacco use (hazard risk = 3.0; 95% confidence interval 1.6-5.6), positive surgical margins (hazard risk = 3.2; 95% confidence interval 1.6-6.1), human papilloma virus-16 (hazard risk = 3.3; 95% confidence interval 1.6-6.9) and age over 45 years (hazard risk = 2.7; 95% confidence interval 1.1-6.6). Conclusions. Establishment of a prognostic score can represent a valuable tool for determining the risk of cervical intraepithelial neoplasia recurrence after conization. The use of clinical (age and tobacco use), pathological (surgical margins) and molecular (human papilloma virus-16 genotyping) factors can facilitate more appropriate patient follow up according to risk stratification. (AU)

• FAPESP's process: 11/19749-6 - Predictive factors of HPV-Induced cytoarchitecture alteration after operative treatment to cervical intraepithelial neoplasia
• Grantee: José Humberto Tavares Guerreiro Fregnani
• Support Opportunities: Regular Research Grants