Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study.
BACKGROUND
In 5-20 % of patients with cervical high-grade squamous intraepithelial lesion (HSIL), a positive margin after the loop electrosurgical excision procedure (LEEP) is associated with persistence/recurrence, but the prognostic value of other clinico-pathological factors is less clear.


METHODS
Among 4336 patients with HSIL who underwent an initial LEEP, 275 (6 %) had HSIL-positive margins, 37 of whom were lost to follow-up. We evaluated the remaining 238 patients. Persistence/recurrence was defined as histopathological HSIL during follow-up.


RESULTS
The age of the patients ranged from 21 to 69 years (median: 40). The median follow-up period was 25 months (range: 6-43). Of the 238 patients, 211 (88.7 %) patients remained free of persistence/recurrence, while 27 (11.3 %) experienced persistence/recurrence. According to a univariate analysis, age (P = 0.03) and maximum specimen diameter (P = 0.043) were associated with persistence/recurrence, but number/location of involved margin sections and the pathology of the endocervical curettage were not (P > 0.10). The relative risk of the subjects (greater than or equal to 35 years ages) was 4.6 times of the subject less than 35 years, the difference was statistically significant (14 % vs. 3 %, P < 0.05). A multivariate analysis indicated that an age of 35 years or older was the only independent risk factor (OR 4.97, 95 % CI 1.14-21.62, P = 0.03).


CONCLUSIONS
In patients with HSIL and HSIL-involved margins after an initial LEEP, age is a strong independent predictor of persistence/recurrence. Follow-up with screening cytology and/or biopsy may be considered in younger patients, whereas a secondary LEEP/hysterectomy may be considered in older patients.
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shen Yang Road 128, Shanghai, 200090, China. zhumenghan90@163.com.
Menghan
M
Zhu
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shen Yang Road 128, Shanghai, 200090, China. snowy816@126.com.
Yuan
Y
He
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shen Yang Road 128, Shanghai, 200090, China. jpabaak47@yahoo.com.|Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China. jpabaak47@yahoo.com.
Jan Pa
JP
Baak
Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. zhouxianrong@sina.com.
Xianrong
X
Zhou
Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. quyuqing0707@126.com.
Yuqing
Y
Qu
Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China. suilong@fudan.edu.cn.|Department of Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. suilong@fudan.edu.cn.
Long
L
Sui
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shen Yang Road 128, Shanghai, 200090, China. wfeng7347@aliyun.com.|Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China. wfeng7347@aliyun.com.
Weiwei
W
Feng
Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China. wqexcel@163.com.|Department of Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. wqexcel@163.com.
Qing
Q
Wang
D000328:Adult; D000368:Aged; D004598:Electrosurgery / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult