title: High-risk human papillomavirus correlates with recurrence after laser ablation for treatment of patients with cervical intraepithelial neoplasia 3: a long-term follow-up retrospective study.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the efficacy of laser ablation as a conservative treatment for cervical intraepithelial neoplasia 3 (CIN3) and assess whether the human papillomavirus (HPV) test is useful to predict recurrence after treatment.
  
  
  METHODS
  A total of 134 patients who received laser ablation for treatment of CIN3 were enrolled in this study. During the follow-up period, patients were followed with cytological and colposcopic evaluations. Recurrence of CIN3 was regarded as the primary end-point. HPV genotype was tested before and after treatment. Post-treatment cumulative recurrence rates were estimated and comparisons by both patient age and HPV genotype were performed.
  
  
  RESULTS
  Overall cumulative recurrence rate of CIN3 in the first year after treatment was 22.6% for all patients. No significant correlation was shown between patient age and recurrence. Patients infected by specific genotypes (16, 18, 31, 33, 52, and 58) frequently failed to clear the infection after treatment. The 1-year recurrence-free survival in those positive after treatment for eight high-risk genotypes (16, 18, 31, 33, 35, 45, 52, and 58) was significantly lower (66.7%), compared to that in those positive for other high-risk types (78.6%). The recurrence-free survival of those who remained HPV-positive after treatment was significantly lower than those who turned negative.
  
  
  CONCLUSIONS
  Laser ablation should be performed prudently with appropriate patient counseling about recurrence rate. Considering its minimal invasiveness, laser ablation is effective, especially for young patients who are negative for eight high-risk genotypes. With regard to HPV testing, although genotyping has significant value for predicting recurrence, screening for all genotypes warrants further evaluation.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Inaba
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nagasaka
authors.forename: Kei
authors.initials: K
authors.lastname: Kawana
authors.forename: Takahide
authors.initials: T
authors.lastname: Arimoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Tsuruga
authors.forename: Mayuyo
authors.initials: M
authors.lastname: Mori-Uchino
authors.forename: Shiho
authors.initials: S
authors.lastname: Miura
authors.forename: Kenbun
authors.initials: K
authors.lastname: Sone
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Oda
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yano
authors.forename: Shiro
authors.initials: S
authors.lastname: Kozuma
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujii
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000235:genetics*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications / Q000821:virology*; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000601:surgery / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000601:surgery / Q000821:virology*
keywords: cervical intraepithelial neoplasia 3; human papillomavirus testing; laser ablation; recurrence; treatment efficacy