title: Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study.
abstract: OBJECTIVE
  To evaluate the risk factors potentially involved in the development of cervical intraepithelial neoplasia (CIN) recurrence after cervical conization in a long-term follow-up period.
  
  
  METHODS
  Consecutive patients with histologically proven CIN who had undergone either cold knife conization or a loop electrosurgical excision procedure were enrolled and scheduled for serial follow-up examinations over a 10-year period. Data were stored in a digital database. Multivariate analysis was performed to identify factors for recurrence.
  
  
  RESULTS
  Between January 1999 and December 2009, 282 patients fulfilled the inclusion criteria and were included in the final statistical analysis. After a median follow-up of 26.7 months (range 6-100), 64 (22.7%) women developed histologically confirmed recurrence. The 2-year recurrence-free survival was 83.7% and 66.7% for women with negative and positive margins, respectively (p=0.008). The 5-year recurrence-free survival was 75.4% and 50.3% for patients with negative and positive margins, respectively (p=0.0004). Positive surgical margin was the most important independent predictor of recurrence [HR 2.5 (95%CI 1.5-4.5), p=0.0007; Wald 11.338]. After multinomial logistic regression the indication for conization based on persistent CIN1 was the only independent predictor for negative margin [OR 0.3 (95%CI 0.1-0.7), p=0.008].
  
  
  CONCLUSIONS
  Our study demonstrated that the surgical margin status represents the most important predictor for CIN recurrence after conization. After excisional therapy, close follow-up is mandatory for the early detection of recurrent disease. The identification of risk factors for recurrence may guide clinical decision-making on expectant management versus re-intervention.
authors: Dept. of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy. mauserati@hotmail.com
authors: Maurizio
authors: M
authors: Serati
authors: Gabriele
authors: G
authors: Siesto
authors: Simona
authors: S
authors: Carollo
authors: Giorgio
authors: G
authors: Formenti
authors: Cristina
authors: C
authors: Riva
authors: Antonella
authors: A
authors: Cromi
authors: Fabio
authors: F
authors: Ghezzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery