Major predictive factors for recurrence of CIN after treatment: an exploratory analysis towards a predictive model.

Objective: Cervical cancer is known as one of the most common malignant tumors in the female population. It can be prevented by early detection and treatment of cervical intraepithelial neoplasia (CIN), which is a recognized precursor. Large Loop Excision of the Transformation Zone (LLETZ) has been widely applied with ideal therapeutic effects. However, 2-25% of patients with HSIL who are treated with LLETZ have been reported to have persistent/recurrent disease. Data about risk stratification and possible influencing factors for recurrence after treatment for CIN are present in the literature, but robust evidence is still lacking. We analyzed data from a well-defined and homogeneous cohort of patients treated for CIN in an Italian referral center for HPV disease to identify significant risk factors that could influence persistent/recurrent disease after treatment.

Patients and methods: We retrospectively collected and reviewed data from 255 patients treated for the first time for CIN in our University Hospital from January 2015 to December 2017 by LLETZ. Demographic data, smoking habits, colposcopy, pre-treatment and follow-up HPV testing, pre-treatment cytology, histology, and treatment histology were collected and analyzed, as well as data about follow-up visits up to date (5 years of maximum follow-up). A multiple logistic regression model was therefore developed to identify the factors that are more predictive of relapse. CIN relapse was recorded when applicable as the main outcome.

Results: As previously underlined by other studies in literature, our results confirmed that HPV positivity after treatment, end margin positivity, higher grading of the lesion at the margin, and smoking habit are significant risk factors for recurrence after treatment for CIN.

Conclusions: With a more and more tailored approach, a validated predictive tool based on the identified significant risk factors could be of great help in the improvement of guidelines and the follow-up of treated patients.