title: Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix: an analysis of 166 cases.
abstract: OBJECTIVE
  The present study assessed the clinical outcome of patients conservatively treated for cervical adenocarcinoma in situ (AIS) and their predictive factors using univariate and multivariate population averaged (PA) generalized estimating equation (GEE) model in a longitudinal setting.
  
  
  METHODS
  A series of 166 consecutive women (mean age 39.8 yrs; range 23-63 yrs) underwent conservative treatment of AIS as the primary treatment and were followed-up (mean 40.9 mo) using colposcopy, PAP-smear, biopsy and HPV-testing with Hybrid Capture 2.
  
  
  RESULTS
  Hysterectomy was performed as part of the primary management in 47 patients, who were excluded from the follow-up (FU) analysis. Out of 119 women closely followed-up, additional therapeutic procedures were performed in 69. At study conclusion, 7 patients (5.9%) showed persistent disease, while 8 (6.7%) had progressed to invasive adenocarcinoma (AC). Positive HR-HPV test was the only independent predictor of disease recurrence (adjusted OR=2.72; 95%CI 1.08-6.87), and together with free cone margins (OR=0.20; 95%CI 0.04-0.92), HR-HPV positivity was also the single most powerful predictor of disease progression to AC, with OR=3.74; 95%CI 1.84-7.61 (p=0.0001) in multivariate PA-GEE.
  
  
  CONCLUSIONS
  These results suggest that testing HR-HPV positive at any time point during FU is the most significant independent predictor of progressive disease, while showing free margins in cone has a significant protective effect against progression to AC. Furthermore, because 4.3% women with persistent, recurrent or progressive disease experienced a late (5th and 6th FU) diagnosis of HG-CGIN or microinvasive AC, a close surveillance should be scheduled for at least three years in conservatively treated AIS patients.
authors.affiliation: Department of Obstetrics and Gynecology, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.forename: Simona
authors.initials: S
authors.lastname: Venturoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Negri
authors.forename: Mario
authors.initials: M
authors.lastname: Sideri
authors.forename: Mario
authors.initials: M
authors.lastname: Preti
authors.forename: Martina
authors.initials: M
authors.lastname: Pesaresi
authors.forename: Adriana
authors.initials: A
authors.lastname: Falasca
authors.forename: Daniela
authors.initials: D
authors.lastname: Barbieri
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zerbini
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sandri
authors.forename: Bruno
authors.initials: B
authors.lastname: Ghiringhello
authors.forename: Nadia
authors.initials: N
authors.lastname: Caroppo Venturini
authors.forename: Stina
authors.initials: S
authors.lastname: Syrjänen
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjänen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D019092:Conization; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*