LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures

Giorgio Bogani, Antonino Ditto, Fabio Martinelli, Lavinia Mosca, Valentina Chiappa, Diego Rossetti, Umberto Leone Roberti Maggiore, Ilaria Sabatucci, Domenica Lorusso, Francesco Raspagliesi

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Abstract

OBJECTIVE: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia.

METHODS: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models.

RESULTS: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups.

CONCLUSIONS: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 50:933-939, 2018. © 2018 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)933-939
Number of pages7
JournalLasers in Surgery and Medicine
Volume50
Issue number9
DOIs
Publication statusPublished - Sep 2018

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Recurrence
Neoplasms
Therapeutics
Proportional Hazards Models
Lasers
Multivariate Analysis
Infection
Population

Cite this

@article{1fc9bc02df734b82be18d502443ad2f3,
title = "LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures",
abstract = "OBJECTIVE: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia.METHODS: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models.RESULTS: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8{\%}) and 35 (17.2{\%}) patients. A total of 41 (20{\%}) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95{\%}CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4{\%}) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8{\%} after excision and 15.7{\%} after ablation; P = 0.424). Similarly, recurrence (17.1{\%} vs. 18.6{\%}; P = 1.00) and lower genital tract (2.8{\%} vs. 1.4{\%}; P = 1.00) rates were similar between groups.CONCLUSIONS: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 50:933-939, 2018. {\circledC} 2018 Wiley Periodicals, Inc.",
author = "Giorgio Bogani and Antonino Ditto and Fabio Martinelli and Lavinia Mosca and Valentina Chiappa and Diego Rossetti and {Leone Roberti Maggiore}, Umberto and Ilaria Sabatucci and Domenica Lorusso and Francesco Raspagliesi",
note = "{\circledC} 2018 Wiley Periodicals, Inc.",
year = "2018",
month = "9",
doi = "10.1002/lsm.22941",
language = "English",
volume = "50",
pages = "933--939",
journal = "Lasers in Surgery and Medicine",
issn = "0196-8092",
publisher = "Wiley-Liss Inc.",
number = "9",

}

TY - JOUR

T1 - LASER treatment for women with high-grade vaginal intraepithelial neoplasia

T2 - A propensity-matched analysis on the efficacy of ablative versus excisional procedures

AU - Bogani, Giorgio

AU - Ditto, Antonino

AU - Martinelli, Fabio

AU - Mosca, Lavinia

AU - Chiappa, Valentina

AU - Rossetti, Diego

AU - Leone Roberti Maggiore, Umberto

AU - Sabatucci, Ilaria

AU - Lorusso, Domenica

AU - Raspagliesi, Francesco

N1 - © 2018 Wiley Periodicals, Inc.

PY - 2018/9

Y1 - 2018/9

N2 - OBJECTIVE: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia.METHODS: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models.RESULTS: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups.CONCLUSIONS: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 50:933-939, 2018. © 2018 Wiley Periodicals, Inc.

AB - OBJECTIVE: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia.METHODS: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models.RESULTS: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups.CONCLUSIONS: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 50:933-939, 2018. © 2018 Wiley Periodicals, Inc.

U2 - 10.1002/lsm.22941

DO - 10.1002/lsm.22941

M3 - Article

C2 - 29756652

VL - 50

SP - 933

EP - 939

JO - Lasers in Surgery and Medicine

JF - Lasers in Surgery and Medicine

SN - 0196-8092

IS - 9

ER -