Nomogram-based prediction of cervical dysplasia persistence/recurrence

Giorgio Bogani, Elena Tagliabue, Stefano Ferla, Fabio Martinelli, Antonino Ditto, Valentina Chiappa, Umberto Leone Roberti Maggiore, Francesca Taverna, Claudia Lombardo, Domenica Lorusso, Francesco Raspagliesi

Research output: Contribution to journalArticle

Abstract

The widespread introduction of screening methods allow to identify cervical dysplasia before having invasive cancer. The risk of developing cervical dysplasia persistence/ recurrence following conization represent a major health issue. Although several studies tried to identify predictors for cervical dysplasia persistence/recurrence, no previous study has been conducted to develop a risk calculator. The current study aimed to identify predictors of cervical dysplasia persistence/recurrence among women undergoing primary conization. We aimed to build nomograms estimating the risk of developing cervical dysplasia recurrence. Data of consecutive women with diagnosis of high-risk human papillomavirus (HPV) undergoing conization were retrospectively evaluated (1503 patients). The risk of developing cervical dysplasia persistence/recurrence was assessed with Kaplan-Meier and Cox's hazard models. Additionally, two nomograms were built to estimate likelihood of cervical dysplasia recurrence: the first based on baseline and operative parameters and the second focusing on type-specific HPV detected. The performance of the above nomograms was assessed using concordance index. A total of 1503 patients were analyzed. After a mean (SD) follow-up of 48.6 ( ± 17.5) months, 84 (5.6%) patients required secondary conization. By multivariate analysis, HIV infection [hazard ratio (HR): 7.78; 95% confidence interval (CI): 2.77-21.81; P < 0.001], positive margins (HR: 26.2; 95% CI: 14.1-48.71; P < 0.001) and persistence of HPV (HR: 6.82; 95% CI: 4.15-11.21; P < 0.001) correlated with cervical intraepithelial neoplasia 2+ persistence/recurrence. The importance of those variables was corroborated by our first nomogram. The second nomogram suggested the impact of type-specific HPV infection in predicting cervical dysplasia persistence/ recurrence. HPV16, HPV18, HPV33, HPV35 and HPV45 were the HPV types most commonly associated with cervical dysplasia persistence/recurrence. The concordance index was greater than 0.70 for both nomograms, thus suggesting the reproducibility of our models. We developed the first two nomograms predicting this risk. The findings of this study require external validation. Once validated our data might be useful to plan a tailored postoperative surveillance of women receiving primary conization.

Original languageEnglish
Pages (from-to)435-440
Number of pages6
JournalEuropean journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP)
Volume28
Issue number5
DOIs
Publication statusPublished - Sep 1 2019

Fingerprint

Uterine Cervical Dysplasia
Nomograms
Conization
Recurrence
Confidence Intervals
Proportional Hazards Models
Cervical Intraepithelial Neoplasia
Papillomavirus Infections
HIV Infections
Multivariate Analysis

ASJC Scopus subject areas

  • Epidemiology
  • Oncology
  • Public Health, Environmental and Occupational Health
  • Cancer Research

Cite this

Nomogram-based prediction of cervical dysplasia persistence/recurrence. / Bogani, Giorgio; Tagliabue, Elena; Ferla, Stefano; Martinelli, Fabio; Ditto, Antonino; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Taverna, Francesca; Lombardo, Claudia; Lorusso, Domenica; Raspagliesi, Francesco.

In: European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP), Vol. 28, No. 5, 01.09.2019, p. 435-440.

Research output: Contribution to journalArticle

@article{3b7bf0286f43493795a255565b387742,
title = "Nomogram-based prediction of cervical dysplasia persistence/recurrence",
abstract = "The widespread introduction of screening methods allow to identify cervical dysplasia before having invasive cancer. The risk of developing cervical dysplasia persistence/ recurrence following conization represent a major health issue. Although several studies tried to identify predictors for cervical dysplasia persistence/recurrence, no previous study has been conducted to develop a risk calculator. The current study aimed to identify predictors of cervical dysplasia persistence/recurrence among women undergoing primary conization. We aimed to build nomograms estimating the risk of developing cervical dysplasia recurrence. Data of consecutive women with diagnosis of high-risk human papillomavirus (HPV) undergoing conization were retrospectively evaluated (1503 patients). The risk of developing cervical dysplasia persistence/recurrence was assessed with Kaplan-Meier and Cox's hazard models. Additionally, two nomograms were built to estimate likelihood of cervical dysplasia recurrence: the first based on baseline and operative parameters and the second focusing on type-specific HPV detected. The performance of the above nomograms was assessed using concordance index. A total of 1503 patients were analyzed. After a mean (SD) follow-up of 48.6 ( ± 17.5) months, 84 (5.6{\%}) patients required secondary conization. By multivariate analysis, HIV infection [hazard ratio (HR): 7.78; 95{\%} confidence interval (CI): 2.77-21.81; P < 0.001], positive margins (HR: 26.2; 95{\%} CI: 14.1-48.71; P < 0.001) and persistence of HPV (HR: 6.82; 95{\%} CI: 4.15-11.21; P < 0.001) correlated with cervical intraepithelial neoplasia 2+ persistence/recurrence. The importance of those variables was corroborated by our first nomogram. The second nomogram suggested the impact of type-specific HPV infection in predicting cervical dysplasia persistence/ recurrence. HPV16, HPV18, HPV33, HPV35 and HPV45 were the HPV types most commonly associated with cervical dysplasia persistence/recurrence. The concordance index was greater than 0.70 for both nomograms, thus suggesting the reproducibility of our models. We developed the first two nomograms predicting this risk. The findings of this study require external validation. Once validated our data might be useful to plan a tailored postoperative surveillance of women receiving primary conization.",
author = "Giorgio Bogani and Elena Tagliabue and Stefano Ferla and Fabio Martinelli and Antonino Ditto and Valentina Chiappa and {Leone Roberti Maggiore}, Umberto and Francesca Taverna and Claudia Lombardo and Domenica Lorusso and Francesco Raspagliesi",
year = "2019",
month = "9",
day = "1",
doi = "10.1097/CEJ.0000000000000475",
language = "English",
volume = "28",
pages = "435--440",
journal = "European Journal of Cancer Prevention",
issn = "0959-8278",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Nomogram-based prediction of cervical dysplasia persistence/recurrence

AU - Bogani, Giorgio

AU - Tagliabue, Elena

AU - Ferla, Stefano

AU - Martinelli, Fabio

AU - Ditto, Antonino

AU - Chiappa, Valentina

AU - Leone Roberti Maggiore, Umberto

AU - Taverna, Francesca

AU - Lombardo, Claudia

AU - Lorusso, Domenica

AU - Raspagliesi, Francesco

PY - 2019/9/1

Y1 - 2019/9/1

N2 - The widespread introduction of screening methods allow to identify cervical dysplasia before having invasive cancer. The risk of developing cervical dysplasia persistence/ recurrence following conization represent a major health issue. Although several studies tried to identify predictors for cervical dysplasia persistence/recurrence, no previous study has been conducted to develop a risk calculator. The current study aimed to identify predictors of cervical dysplasia persistence/recurrence among women undergoing primary conization. We aimed to build nomograms estimating the risk of developing cervical dysplasia recurrence. Data of consecutive women with diagnosis of high-risk human papillomavirus (HPV) undergoing conization were retrospectively evaluated (1503 patients). The risk of developing cervical dysplasia persistence/recurrence was assessed with Kaplan-Meier and Cox's hazard models. Additionally, two nomograms were built to estimate likelihood of cervical dysplasia recurrence: the first based on baseline and operative parameters and the second focusing on type-specific HPV detected. The performance of the above nomograms was assessed using concordance index. A total of 1503 patients were analyzed. After a mean (SD) follow-up of 48.6 ( ± 17.5) months, 84 (5.6%) patients required secondary conization. By multivariate analysis, HIV infection [hazard ratio (HR): 7.78; 95% confidence interval (CI): 2.77-21.81; P < 0.001], positive margins (HR: 26.2; 95% CI: 14.1-48.71; P < 0.001) and persistence of HPV (HR: 6.82; 95% CI: 4.15-11.21; P < 0.001) correlated with cervical intraepithelial neoplasia 2+ persistence/recurrence. The importance of those variables was corroborated by our first nomogram. The second nomogram suggested the impact of type-specific HPV infection in predicting cervical dysplasia persistence/ recurrence. HPV16, HPV18, HPV33, HPV35 and HPV45 were the HPV types most commonly associated with cervical dysplasia persistence/recurrence. The concordance index was greater than 0.70 for both nomograms, thus suggesting the reproducibility of our models. We developed the first two nomograms predicting this risk. The findings of this study require external validation. Once validated our data might be useful to plan a tailored postoperative surveillance of women receiving primary conization.

AB - The widespread introduction of screening methods allow to identify cervical dysplasia before having invasive cancer. The risk of developing cervical dysplasia persistence/ recurrence following conization represent a major health issue. Although several studies tried to identify predictors for cervical dysplasia persistence/recurrence, no previous study has been conducted to develop a risk calculator. The current study aimed to identify predictors of cervical dysplasia persistence/recurrence among women undergoing primary conization. We aimed to build nomograms estimating the risk of developing cervical dysplasia recurrence. Data of consecutive women with diagnosis of high-risk human papillomavirus (HPV) undergoing conization were retrospectively evaluated (1503 patients). The risk of developing cervical dysplasia persistence/recurrence was assessed with Kaplan-Meier and Cox's hazard models. Additionally, two nomograms were built to estimate likelihood of cervical dysplasia recurrence: the first based on baseline and operative parameters and the second focusing on type-specific HPV detected. The performance of the above nomograms was assessed using concordance index. A total of 1503 patients were analyzed. After a mean (SD) follow-up of 48.6 ( ± 17.5) months, 84 (5.6%) patients required secondary conization. By multivariate analysis, HIV infection [hazard ratio (HR): 7.78; 95% confidence interval (CI): 2.77-21.81; P < 0.001], positive margins (HR: 26.2; 95% CI: 14.1-48.71; P < 0.001) and persistence of HPV (HR: 6.82; 95% CI: 4.15-11.21; P < 0.001) correlated with cervical intraepithelial neoplasia 2+ persistence/recurrence. The importance of those variables was corroborated by our first nomogram. The second nomogram suggested the impact of type-specific HPV infection in predicting cervical dysplasia persistence/ recurrence. HPV16, HPV18, HPV33, HPV35 and HPV45 were the HPV types most commonly associated with cervical dysplasia persistence/recurrence. The concordance index was greater than 0.70 for both nomograms, thus suggesting the reproducibility of our models. We developed the first two nomograms predicting this risk. The findings of this study require external validation. Once validated our data might be useful to plan a tailored postoperative surveillance of women receiving primary conization.

UR - http://www.scopus.com/inward/record.url?scp=85071150849&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071150849&partnerID=8YFLogxK

U2 - 10.1097/CEJ.0000000000000475

DO - 10.1097/CEJ.0000000000000475

M3 - Article

C2 - 30489353

AN - SCOPUS:85071150849

VL - 28

SP - 435

EP - 440

JO - European Journal of Cancer Prevention

JF - European Journal of Cancer Prevention

SN - 0959-8278

IS - 5

ER -