The association of pre-treatment HPV subtypes with recurrence of VIN

Giorgio Bogani, Fabio Martinelli, Antonino Ditto, Mauro Signorelli, Francesca Taverna, Claudia Lombardo, Valentina Chiappa, Umberto Leone Roberti Maggiore, Dario Recalcati, Cono Scaffa, Stefania Perotto, Ilaria Sabatucci, Alice Indini, Domenica Lorusso, Francesco Raspagliesi

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective To assess whether pre-treatment HPV types are associated with recurrence of high-grade vulvar intraepithelial neoplasia (VIN2+). Study design Data of consecutive patients with pretreatment HPV DNA test undergoing treatment for VIN2+ were retrospectively collected. Risk factors promoting the risk of VIN2+ persistence and recurrence were analyzed using Kaplan-Meier and Cox hazard proportional models. Results 64 patients had pretreatment vulvar-vaginal HPV DNA test. Two were excluded due to the presence of synchronous vulvar cancer, thus leaving 62 patients for the final analysis. HPV16, HPV18, HPV31 and HPV33 were the most common HPV genotype detected, occurring in 15 (24.2%), 4 (6.5%), 8 (12.9%) and 5 (8.0%) patients, respectively. HPV was not detected in 19 (30.6%) patients. During a mean (SD) follow up of 56.7 (±26.7) months, 10 (16.1%) patients had VIN2+ persistence/recurrence. Mean (SD) lesion-free interval was 51.7 (±31.4) months. Via multivariate analysis, pretreatment infection from HPV31 (HR:46.7(95%CI:4.21,518.4); p = 0.02) and HPV33 (HR:77.0(95%CI:6.73,881.9); p < 0.001) correlated with an increased risk of VIN2+ persistence/recurrence. Additionally, we observed that patients undergoing surgical excision followed by LASER ablation experienced a trend towards lower recurrence rate than patients undergoing other surgical or medical treatments (HR:0.20(95%CI:0.03,1.09); p = 0.05). Two (3.2%) patients developed progression to vulvar cancer. Conclusions Owing to the inherent biases of the retrospective study design and the small sample size, our data have to be corroborated by larger and prospective studies. HPV31 and HPV33 have a potential role in predicting VIN2+ persistence/recurrence. These findings will be paramount, owing to the implementation of new immunization programs.

Original languageEnglish
Pages (from-to)37-41
Number of pages5
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume211
DOIs
Publication statusPublished - Apr 1 2017

Fingerprint

Recurrence
Human Papillomavirus DNA Tests
Vulvar Neoplasms
Therapeutics
Immunization Programs
Proportional Hazards Models
Sample Size
Multivariate Analysis
Retrospective Studies
Genotype
Prospective Studies
Infection
Neoplasms

Keywords

  • HPV
  • Persistence
  • Recurrence
  • VIN
  • Vulvar cancer
  • Vulvar intraepithelial neoplasia

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

The association of pre-treatment HPV subtypes with recurrence of VIN. / Bogani, Giorgio; Martinelli, Fabio; Ditto, Antonino; Signorelli, Mauro; Taverna, Francesca; Lombardo, Claudia; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Recalcati, Dario; Scaffa, Cono; Perotto, Stefania; Sabatucci, Ilaria; Indini, Alice; Lorusso, Domenica; Raspagliesi, Francesco.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 211, 01.04.2017, p. 37-41.

Research output: Contribution to journalArticle

Bogani, Giorgio ; Martinelli, Fabio ; Ditto, Antonino ; Signorelli, Mauro ; Taverna, Francesca ; Lombardo, Claudia ; Chiappa, Valentina ; Leone Roberti Maggiore, Umberto ; Recalcati, Dario ; Scaffa, Cono ; Perotto, Stefania ; Sabatucci, Ilaria ; Indini, Alice ; Lorusso, Domenica ; Raspagliesi, Francesco. / The association of pre-treatment HPV subtypes with recurrence of VIN. In: European Journal of Obstetrics Gynecology and Reproductive Biology. 2017 ; Vol. 211. pp. 37-41.
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abstract = "Objective To assess whether pre-treatment HPV types are associated with recurrence of high-grade vulvar intraepithelial neoplasia (VIN2+). Study design Data of consecutive patients with pretreatment HPV DNA test undergoing treatment for VIN2+ were retrospectively collected. Risk factors promoting the risk of VIN2+ persistence and recurrence were analyzed using Kaplan-Meier and Cox hazard proportional models. Results 64 patients had pretreatment vulvar-vaginal HPV DNA test. Two were excluded due to the presence of synchronous vulvar cancer, thus leaving 62 patients for the final analysis. HPV16, HPV18, HPV31 and HPV33 were the most common HPV genotype detected, occurring in 15 (24.2{\%}), 4 (6.5{\%}), 8 (12.9{\%}) and 5 (8.0{\%}) patients, respectively. HPV was not detected in 19 (30.6{\%}) patients. During a mean (SD) follow up of 56.7 (±26.7) months, 10 (16.1{\%}) patients had VIN2+ persistence/recurrence. Mean (SD) lesion-free interval was 51.7 (±31.4) months. Via multivariate analysis, pretreatment infection from HPV31 (HR:46.7(95{\%}CI:4.21,518.4); p = 0.02) and HPV33 (HR:77.0(95{\%}CI:6.73,881.9); p < 0.001) correlated with an increased risk of VIN2+ persistence/recurrence. Additionally, we observed that patients undergoing surgical excision followed by LASER ablation experienced a trend towards lower recurrence rate than patients undergoing other surgical or medical treatments (HR:0.20(95{\%}CI:0.03,1.09); p = 0.05). Two (3.2{\%}) patients developed progression to vulvar cancer. Conclusions Owing to the inherent biases of the retrospective study design and the small sample size, our data have to be corroborated by larger and prospective studies. HPV31 and HPV33 have a potential role in predicting VIN2+ persistence/recurrence. These findings will be paramount, owing to the implementation of new immunization programs.",
keywords = "HPV, Persistence, Recurrence, VIN, Vulvar cancer, Vulvar intraepithelial neoplasia",
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AU - Bogani, Giorgio

AU - Martinelli, Fabio

AU - Ditto, Antonino

AU - Signorelli, Mauro

AU - Taverna, Francesca

AU - Lombardo, Claudia

AU - Chiappa, Valentina

AU - Leone Roberti Maggiore, Umberto

AU - Recalcati, Dario

AU - Scaffa, Cono

AU - Perotto, Stefania

AU - Sabatucci, Ilaria

AU - Indini, Alice

AU - Lorusso, Domenica

AU - Raspagliesi, Francesco

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Objective To assess whether pre-treatment HPV types are associated with recurrence of high-grade vulvar intraepithelial neoplasia (VIN2+). Study design Data of consecutive patients with pretreatment HPV DNA test undergoing treatment for VIN2+ were retrospectively collected. Risk factors promoting the risk of VIN2+ persistence and recurrence were analyzed using Kaplan-Meier and Cox hazard proportional models. Results 64 patients had pretreatment vulvar-vaginal HPV DNA test. Two were excluded due to the presence of synchronous vulvar cancer, thus leaving 62 patients for the final analysis. HPV16, HPV18, HPV31 and HPV33 were the most common HPV genotype detected, occurring in 15 (24.2%), 4 (6.5%), 8 (12.9%) and 5 (8.0%) patients, respectively. HPV was not detected in 19 (30.6%) patients. During a mean (SD) follow up of 56.7 (±26.7) months, 10 (16.1%) patients had VIN2+ persistence/recurrence. Mean (SD) lesion-free interval was 51.7 (±31.4) months. Via multivariate analysis, pretreatment infection from HPV31 (HR:46.7(95%CI:4.21,518.4); p = 0.02) and HPV33 (HR:77.0(95%CI:6.73,881.9); p < 0.001) correlated with an increased risk of VIN2+ persistence/recurrence. Additionally, we observed that patients undergoing surgical excision followed by LASER ablation experienced a trend towards lower recurrence rate than patients undergoing other surgical or medical treatments (HR:0.20(95%CI:0.03,1.09); p = 0.05). Two (3.2%) patients developed progression to vulvar cancer. Conclusions Owing to the inherent biases of the retrospective study design and the small sample size, our data have to be corroborated by larger and prospective studies. HPV31 and HPV33 have a potential role in predicting VIN2+ persistence/recurrence. These findings will be paramount, owing to the implementation of new immunization programs.

AB - Objective To assess whether pre-treatment HPV types are associated with recurrence of high-grade vulvar intraepithelial neoplasia (VIN2+). Study design Data of consecutive patients with pretreatment HPV DNA test undergoing treatment for VIN2+ were retrospectively collected. Risk factors promoting the risk of VIN2+ persistence and recurrence were analyzed using Kaplan-Meier and Cox hazard proportional models. Results 64 patients had pretreatment vulvar-vaginal HPV DNA test. Two were excluded due to the presence of synchronous vulvar cancer, thus leaving 62 patients for the final analysis. HPV16, HPV18, HPV31 and HPV33 were the most common HPV genotype detected, occurring in 15 (24.2%), 4 (6.5%), 8 (12.9%) and 5 (8.0%) patients, respectively. HPV was not detected in 19 (30.6%) patients. During a mean (SD) follow up of 56.7 (±26.7) months, 10 (16.1%) patients had VIN2+ persistence/recurrence. Mean (SD) lesion-free interval was 51.7 (±31.4) months. Via multivariate analysis, pretreatment infection from HPV31 (HR:46.7(95%CI:4.21,518.4); p = 0.02) and HPV33 (HR:77.0(95%CI:6.73,881.9); p < 0.001) correlated with an increased risk of VIN2+ persistence/recurrence. Additionally, we observed that patients undergoing surgical excision followed by LASER ablation experienced a trend towards lower recurrence rate than patients undergoing other surgical or medical treatments (HR:0.20(95%CI:0.03,1.09); p = 0.05). Two (3.2%) patients developed progression to vulvar cancer. Conclusions Owing to the inherent biases of the retrospective study design and the small sample size, our data have to be corroborated by larger and prospective studies. HPV31 and HPV33 have a potential role in predicting VIN2+ persistence/recurrence. These findings will be paramount, owing to the implementation of new immunization programs.

KW - HPV

KW - Persistence

KW - Recurrence

KW - VIN

KW - Vulvar cancer

KW - Vulvar intraepithelial neoplasia

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