Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix: An analysis of 166 cases

Silvano Costa, Simona Venturoli, Giovanni Negri, Mario Sideri, Mario Preti, Martina Pesaresi, Adriana Falasca, Daniela Barbieri, Marialuisa Zerbini, Donatella Santini, Maria Teresa Sandri, Bruno Ghiringhello, Nadia Caroppo Venturini, Stina Syrjänen, Kari Syrjänen

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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 23-63 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 1.08-6.87), and together with free cone margins (OR = 0.20; 95%CI 0.04-0.92), HR-HPV positivity was also the single most powerful predictor of disease progression to AC, with OR = 3.74; 95%CI 1.84-7.61 (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.

Original languageEnglish
Pages (from-to)490-495
Number of pages6
JournalGynecologic Oncology
Volume124
Issue number3
DOIs
Publication statusPublished - Mar 2012

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Cervix Uteri
Adenocarcinoma
Colposcopy
Hysterectomy
Population
Disease Progression
Biopsy
Recurrence
Adenocarcinoma in Situ
Therapeutics

Keywords

  • Adenocarcinoma in situ
  • Conservative treatment
  • Follow-up, test performance
  • Predictive factors, PA-GEE models

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix : An analysis of 166 cases. / Costa, Silvano; Venturoli, Simona; Negri, Giovanni; Sideri, Mario; Preti, Mario; Pesaresi, Martina; Falasca, Adriana; Barbieri, Daniela; Zerbini, Marialuisa; Santini, Donatella; Sandri, Maria Teresa; Ghiringhello, Bruno; Caroppo Venturini, Nadia; Syrjänen, Stina; Syrjänen, Kari.

In: Gynecologic Oncology, Vol. 124, No. 3, 03.2012, p. 490-495.

Research output: Contribution to journalArticle

Costa, S, Venturoli, S, Negri, G, Sideri, M, Preti, M, Pesaresi, M, Falasca, A, Barbieri, D, Zerbini, M, Santini, D, Sandri, MT, Ghiringhello, B, Caroppo Venturini, N, Syrjänen, S & Syrjänen, K 2012, 'Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix: An analysis of 166 cases', Gynecologic Oncology, vol. 124, no. 3, pp. 490-495. https://doi.org/10.1016/j.ygyno.2011.11.039
Costa, Silvano ; Venturoli, Simona ; Negri, Giovanni ; Sideri, Mario ; Preti, Mario ; Pesaresi, Martina ; Falasca, Adriana ; Barbieri, Daniela ; Zerbini, Marialuisa ; Santini, Donatella ; Sandri, Maria Teresa ; Ghiringhello, Bruno ; Caroppo Venturini, Nadia ; Syrjänen, Stina ; Syrjänen, Kari. / Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix : An analysis of 166 cases. In: Gynecologic Oncology. 2012 ; Vol. 124, No. 3. pp. 490-495.
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abstract = "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 23-63 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 1.08-6.87), and together with free cone margins (OR = 0.20; 95{\%}CI 0.04-0.92), HR-HPV positivity was also the single most powerful predictor of disease progression to AC, with OR = 3.74; 95{\%}CI 1.84-7.61 (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.",
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AU - Zerbini, Marialuisa

AU - Santini, Donatella

AU - Sandri, Maria Teresa

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