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Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up

Andrade, Carlos E.M.C. ; Scapulatempo-Neto, Cristovam ; Longatto-Filho, Adhemar ; Vieira, Marcelo A. ; Tsunoda, Audrey T. ; Da Silva, Ismael D.C.G. ; Fregnani, José Humberto T.G.

Acta obstetricia et gynecologica Scandinavica, 2014-09, Vol.93 (9), p.941-948 [Periódico revisado por pares]

United States: Blackwell Publishing Ltd

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  • Título:
    Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up
  • Autor: Andrade, Carlos E.M.C. ; Scapulatempo-Neto, Cristovam ; Longatto-Filho, Adhemar ; Vieira, Marcelo A. ; Tsunoda, Audrey T. ; Da Silva, Ismael D.C.G. ; Fregnani, José Humberto T.G.
  • Assuntos: Aged ; Cervical intraepithelial neoplasia ; Cervical Intraepithelial Neoplasia - pathology ; Cervical Intraepithelial Neoplasia - surgery ; conization ; Female ; Follow-Up Studies ; HPV DNA tests ; human papillomavirus ; Humans ; Middle Aged ; Models, Anatomic ; Postoperative Period ; Prognosis ; recurrence ; Risk Factors ; Treatment Outcome ; Uterine Cervical Neoplasms - pathology ; Uterine Cervical Neoplasms - surgery
  • É parte de: Acta obstetricia et gynecologica Scandinavica, 2014-09, Vol.93 (9), p.941-948
  • Notas: FAPESP - No. 2011/19749-6
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  • Descrição: Objective To develop a prognostic model for women who underwent surgical treatment for cervical intraepithelial neoplasia. Design Cohort study. Patient inclusion and follow‐up occurred retrospectively and prospectively. Setting Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Population Women (n = 242) diagnosed with cervical intraepithelial neoplasia who were submitted to conization. Methods Immediately prior to surgical treatment, a cervical cytology sample was collected from each individual included in the study by endocervical brushing and stored in a preservative solution with methanol. A human papilloma virus‐DNA test was conducted using an aliquot of the endocervical brushings. The surgical specimens were subjected to immunohistochemical analysis of p16 (immunohistochemical analysis 4a) protein expression. Main outcome measures Two‐year disease‐free survival rates calculated for each study variable. Identified variables in the multivariate Cox model were used for elaboration of prognostic scores. Results Variables associated with outcome included age (p = 0.033), tobacco use (p < 0.001), final histopathological diagnosis (p = 0.007), surgical margins (p < 0.001), high‐risk human papilloma virus status (p = 0.008), human papilloma virus‐16 status (p < 0.001) and immunoexpression of p16 in the cytoplasm (p = 0.049). By the Cox model, independent risk factors for disease recurrence/persistence were: tobacco use (hazard risk = 3.0; 95% confidence interval 1.6–5.6), positive surgical margins (hazard risk = 3.2; 95% confidence interval 1.6–6.1), human papilloma virus‐16 (hazard risk = 3.3; 95% confidence interval 1.6–6.9) and age over 45 years (hazard risk = 2.7; 95% confidence interval 1.1–6.6). Conclusions Establishment of a prognostic score can represent a valuable tool for determining the risk of cervical intraepithelial neoplasia recurrence after conization. The use of clinical (age and tobacco use), pathological (surgical margins) and molecular (human papilloma virus‐16 genotyping) factors can facilitate more appropriate patient follow up according to risk stratification.
  • Editor: United States: Blackwell Publishing Ltd
  • Idioma: Inglês;Francês;Alemão
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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