Human papillomavirus (HPV) persistence and HPV 31 predict the risk of recurrence in high-grade vaginal intraepithelial neoplasia

Giorgio Bogani, Fabio Martinelli, Antonino Ditto, Francesca Taverna, Claudia Lombardo, Mauro Signorelli, Valentina Chiappa, Umberto Leone Roberti Maggiore, Caterina Fontanella, Ilaria Sabatucci, Chiara Borghi, Dario Recalcati, Alice Indini, Domenica Lorusso, Francesco Raspagliesi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective High-grade vaginal intraepithelial neoplasia (vaginal HSIL) represents an uncommon entity. Here, we sought to identify predictors for recurrence and risk factor for developing genital cancers after primary treatment for vaginal HSIL. Methods Data of consecutive 5104 women who had human papillomavirus (HPV) DNA test were searched for identify women with histological confirmed vaginal HSIL. Disease-free interval and the risk of developing HPV-related gynecological cancers were assessed using Kaplan-Meier and Cox proportional hazard models. Results Overall, 77 patients were included. After a mean (SD) follow-up of 69.3 (33.0) months, 11 (14%) and 4 (5%) patients experienced vaginal HSIL recurrence and the occurrence of HPV-related gynecological cancers, respectively. Via multivariate analysis factors predicting for vaginal HSIL recurrence were infection from HPV31 at diagnosis (HR: 5.0 (95%CI:1.17, 21.3); p = 0.03) and persistence of HPV infection after treatment (HR: 7.0 (95%CI:1.54, 31.6); p = 0.01). Additionally, patients who had LASER ablation experienced a trend toward a lower risk of recurrence in comparison to medical treatment (HR: 0.20 (95%CI:0.03, 1.09); p = 0.06). Considering the occurrence of HPV-related gynecological cancers, we observed that no factors independently correlated with this risk; while, a trend towards higher risk was observed for women with HIV infection (HR:16.4 (95%CI:0.90, 300.1); p = 0.06) and persistence of HPV infection (HR: 13.3 (95%CI:0.76, 230.2); p = 0.07). Conclusions Patients affected by vaginal HSIL experienced a relatively high risk of recurrence. Persistence of HPV after treatment and pretreatment HPV-31 infection predicts for high-grade vaginal intraepithelial neoplasia recurrence. Further investigations are warranted in order to corroborate our data.

Original languageEnglish
Pages (from-to)157-165
Number of pages9
JournalEuropean Journal of Obstetrics, Gynecology and Reproductive Biology
Volume210
DOIs
Publication statusPublished - Mar 1 2017

Keywords

  • Genital cancer
  • HPV
  • Neoplasia
  • Vaginal intraepithelial neoplasia
  • VAIN

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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