Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

G. BOGANI; V. DI DONATO; F. SOPRACORDEVOLE; A. CIAVATTINI; A. GHELARDI; S. LOPEZ; T. SIMONCINI; F. PLOTTI; J. CASARIN; M. SERATI; C. PINELLI; G. VALENTI; A. BERGAMINI; B. GARDELLA; A. DELL'ACQUA; E. MONTI; P. VERCELLINI; M. FISCHETTI; G. D'IPPOLITO; L. AGUZZOLI; V.D. MANDATO; P. CARUNCHIO; G. CARLINFANTE; L. GIANNELLA; C. SCAFFA; F. FALCONE; C. BORGHI; A. DITTO; M. MALZONI; A. GIANNINI; M.G. SALERNO; V. LIBERALE; B. CONTINO; C. DONFRANCESCO; M. DESIATO; A.M. PERRONE; G. DONDI; P. De IACO; U. LEONE ROBERTI MAGGIORE; M. SIGNORELLI; V. CHIAPPA; S. FERRERO; G. SARPIETRO; M.G. MATARAZZO; A. CIANCI; S. BOSIO; S. RUISI; R. GUERRISI; C. BRUSADELLI; L. MOSCA; R. TINELLI; R. DE VINCENZO; G.F. ZANNONI; G. FERRANDINA; M. PETRILLO; S. DESSOLE; R. ANGIOLI; S. GREGGI; A. SPINILLO; F. GHEZZI; N. COLACURCI; L. MUZII; P. BENEDETTI PANICI; G. SCAMBIA; F. RASPAGLIESI

doi:10.1016/j.ygyno.2020.08.025

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

G. BOGANI, V. DI DONATO, F. SOPRACORDEVOLE, A. CIAVATTINI, A. GHELARDI, S. LOPEZ, T. SIMONCINI, F. PLOTTI, J. CASARIN, M. SERATI, C. PINELLI, G. VALENTI, A. BERGAMINI, B. GARDELLA, A. DELL'ACQUA, E. MONTI, P. VERCELLINI, M. FISCHETTI, G. D'IPPOLITO, L. AGUZZOLIV.D. MANDATO, P. CARUNCHIO, G. CARLINFANTE, L. GIANNELLA, C. SCAFFA, F. FALCONE, C. BORGHI, A. DITTO, M. MALZONI, A. GIANNINI, M.G. SALERNO, V. LIBERALE, B. CONTINO, C. DONFRANCESCO, M. DESIATO, A.M. PERRONE, G. DONDI, P. De IACO, U. LEONE ROBERTI MAGGIORE, M. SIGNORELLI, V. CHIAPPA, S. FERRERO, G. SARPIETRO, M.G. MATARAZZO, A. CIANCI, S. BOSIO, S. RUISI, R. GUERRISI, C. BRUSADELLI, L. MOSCA, R. TINELLI, R. DE VINCENZO, G.F. ZANNONI, G. FERRANDINA, M. PETRILLO, S. DESSOLE, R. ANGIOLI, S. GREGGI, A. SPINILLO, F. GHEZZI, N. COLACURCI, L. MUZII, P. BENEDETTI PANICI, G. SCAMBIA, F. RASPAGLIESI

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Abstract

Objective: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p <0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p <0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5–]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). Conclusions: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia. © 2020

Original language	English
Journal	Gynecol. Oncol.
DOIs	https://doi.org/10.1016/j.ygyno.2020.08.025
Publication status	Published - 2020

Keywords

ONCOLOGIA
STUDIO CLINICO
RIS

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10.1016/j.ygyno.2020.08.025

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BOGANI, G., DI DONATO, V., SOPRACORDEVOLE, F., CIAVATTINI, A., GHELARDI, A., LOPEZ, S., SIMONCINI, T., PLOTTI, F., CASARIN, J., SERATI, M., PINELLI, C., VALENTI, G., BERGAMINI, A., GARDELLA, B., DELL'ACQUA, A., MONTI, E., VERCELLINI, P., FISCHETTI, M., D'IPPOLITO, G., ... RASPAGLIESI, F. (2020). Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study. Gynecol. Oncol. https://doi.org/10.1016/j.ygyno.2020.08.025

BOGANI, G, DI DONATO, V, SOPRACORDEVOLE, F, CIAVATTINI, A, GHELARDI, A, LOPEZ, S, SIMONCINI, T, PLOTTI, F, CASARIN, J, SERATI, M, PINELLI, C, VALENTI, G, BERGAMINI, A, GARDELLA, B, DELL'ACQUA, A, MONTI, E , VERCELLINI, P, FISCHETTI, M, D'IPPOLITO, G, AGUZZOLI, L , MANDATO, VD, CARUNCHIO, P, CARLINFANTE, G, GIANNELLA, L, SCAFFA, C, FALCONE, F, BORGHI, C, DITTO, A, MALZONI, M, GIANNINI, A, SALERNO, MG, LIBERALE, V, CONTINO, B, DONFRANCESCO, C, DESIATO, M, PERRONE, AM, DONDI, G, De IACO, P, LEONE ROBERTI MAGGIORE, U , SIGNORELLI, M , CHIAPPA, V , FERRERO, S, SARPIETRO, G, MATARAZZO, MG, CIANCI, A, BOSIO, S, RUISI, S, GUERRISI, R, BRUSADELLI, C, MOSCA, L, TINELLI, R, DE VINCENZO, R, ZANNONI, GF, FERRANDINA, G, PETRILLO, M, DESSOLE, S, ANGIOLI, R, GREGGI, S , SPINILLO, A, GHEZZI, F, COLACURCI, N, MUZII, L, BENEDETTI PANICI, P, SCAMBIA, G & RASPAGLIESI, F 2020, 'Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study', Gynecol. Oncol. https://doi.org/10.1016/j.ygyno.2020.08.025

@article{87e0bbb689794d40a3a681d1d40c3a17,

title = "Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study",

abstract = "Objective: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p <0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p <0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5–]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). Conclusions: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia. {\textcopyright} 2020",

keywords = "ONCOLOGIA, STUDIO CLINICO, RIS",

author = "G. BOGANI and {DI DONATO}, V. and F. SOPRACORDEVOLE and A. CIAVATTINI and A. GHELARDI and S. LOPEZ and T. SIMONCINI and F. PLOTTI and J. CASARIN and M. SERATI and C. PINELLI and G. VALENTI and A. BERGAMINI and B. GARDELLA and A. DELL'ACQUA and E. MONTI and P. VERCELLINI and M. FISCHETTI and G. D'IPPOLITO and L. AGUZZOLI and V.D. MANDATO and P. CARUNCHIO and G. CARLINFANTE and L. GIANNELLA and C. SCAFFA and F. FALCONE and C. BORGHI and A. DITTO and M. MALZONI and A. GIANNINI and M.G. SALERNO and V. LIBERALE and B. CONTINO and C. DONFRANCESCO and M. DESIATO and A.M. PERRONE and G. DONDI and {De IACO}, P. and {LEONE ROBERTI MAGGIORE}, U. and M. SIGNORELLI and V. CHIAPPA and S. FERRERO and G. SARPIETRO and M.G. MATARAZZO and A. CIANCI and S. BOSIO and S. RUISI and R. GUERRISI and C. BRUSADELLI and L. MOSCA and R. TINELLI and {DE VINCENZO}, R. and G.F. ZANNONI and G. FERRANDINA and M. PETRILLO and S. DESSOLE and R. ANGIOLI and S. GREGGI and A. SPINILLO and F. GHEZZI and N. COLACURCI and L. MUZII and {BENEDETTI PANICI}, P. and G. SCAMBIA and F. RASPAGLIESI",

year = "2020",

doi = "10.1016/j.ygyno.2020.08.025",

language = "English",

journal = "Gynecol. Oncol.",

issn = "0090-8258",

}

TY - JOUR

T1 - Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

AU - BOGANI, G.

AU - DI DONATO, V.

AU - SOPRACORDEVOLE, F.

AU - CIAVATTINI, A.

AU - GHELARDI, A.

AU - LOPEZ, S.

AU - SIMONCINI, T.

AU - PLOTTI, F.

AU - CASARIN, J.

AU - SERATI, M.

AU - PINELLI, C.

AU - VALENTI, G.

AU - BERGAMINI, A.

AU - GARDELLA, B.

AU - DELL'ACQUA, A.

AU - MONTI, E.

AU - VERCELLINI, P.

AU - FISCHETTI, M.

AU - D'IPPOLITO, G.

AU - AGUZZOLI, L.

AU - MANDATO, V.D.

AU - CARUNCHIO, P.

AU - CARLINFANTE, G.

AU - GIANNELLA, L.

AU - SCAFFA, C.

AU - FALCONE, F.

AU - BORGHI, C.

AU - DITTO, A.

AU - MALZONI, M.

AU - GIANNINI, A.

AU - SALERNO, M.G.

AU - LIBERALE, V.

AU - CONTINO, B.

AU - DONFRANCESCO, C.

AU - DESIATO, M.

AU - PERRONE, A.M.

AU - DONDI, G.

AU - De IACO, P.

AU - LEONE ROBERTI MAGGIORE, U.

AU - SIGNORELLI, M.

AU - CHIAPPA, V.

AU - FERRERO, S.

AU - SARPIETRO, G.

AU - MATARAZZO, M.G.

AU - CIANCI, A.

AU - BOSIO, S.

AU - RUISI, S.

AU - GUERRISI, R.

AU - BRUSADELLI, C.

AU - MOSCA, L.

AU - TINELLI, R.

AU - DE VINCENZO, R.

AU - ZANNONI, G.F.

AU - FERRANDINA, G.

AU - PETRILLO, M.

AU - DESSOLE, S.

AU - ANGIOLI, R.

AU - GREGGI, S.

AU - SPINILLO, A.

AU - GHEZZI, F.

AU - COLACURCI, N.

AU - MUZII, L.

AU - BENEDETTI PANICI, P.

AU - SCAMBIA, G.

AU - RASPAGLIESI, F.

PY - 2020

Y1 - 2020

N2 - Objective: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p <0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p <0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5–]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). Conclusions: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia. © 2020

AB - Objective: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p <0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p <0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5–]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). Conclusions: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia. © 2020

KW - ONCOLOGIA

KW - STUDIO CLINICO

KW - RIS

U2 - 10.1016/j.ygyno.2020.08.025

DO - 10.1016/j.ygyno.2020.08.025

M3 - Article

JO - Gynecol. Oncol.

JF - Gynecol. Oncol.

SN - 0090-8258

ER -

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

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