1. Long-Term Follow-Up Outcomes in Women with In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix Undergoing Conservative Treatment—Cervical Adenocarcinoma Study Group Italian Society of Colposcopy and Cervico-Vaginal Pathology.
- Author
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Giannella, Luca, Delli Carpini, Giovanni, Di Giuseppe, Jacopo, Grelloni, Camilla, Bogani, Giorgio, Dri, Marco, Sopracordevole, Francesco, Clemente, Nicolò, Giorda, Giorgio, De Vincenzo, Rosa, Evangelista, Maria Teresa, Gardella, Barbara, Dominoni, Mattia, Monti, Ermelinda, Alessi, Chiara, Alessandrini, Lara, Guerriero, Angela, Pagan, Alessio, Caretto, Marta, and Ghelardi, Alessandro
- Subjects
ADENOCARCINOMA ,CONSERVATIVE treatment ,UTERINE tumors ,CERVIX uteri tumors ,CANCER invasiveness ,VAGINA ,LOGISTIC regression analysis ,EVALUATION of medical care ,TREATMENT effectiveness ,RETROSPECTIVE studies ,KAPLAN-Meier estimator ,LOG-rank test ,ODDS ratio ,LONGITUDINAL method ,COLPOSCOPY ,RESEARCH methodology ,WOMEN'S health ,CONFIDENCE intervals ,DATA analysis software ,SURVIVAL analysis (Biometry) ,CARCINOMA in situ ,PATIENT aftercare ,CERVIX uteri - Abstract
Simple Summary: In situ/microinvasive adenocarcinoma of the uterine cervix represents the majority of cervical glandular lesions and can be treated conservatively. In contrast to squamous lesions, approximately 15–20% of glandular disease may be HPV-negative and therefore associated with a worse prognosis. Furthermore, up to 4% of cases may show recurrence after three years of follow-up. Given the abovementioned risk, knowing the predictive factors of disease recurrence becomes crucial for post-treatment management. In the present study, HPV testing in follow-up was the best predictor for recurrences in women with in situ/microinvasive AC undergoing conservative treatment. So, its use in clinical practice is of pivotal importance. However, attention should be paid to non-high-risk HPV women in follow-up with non-usual-type histopathology, given that it seems to represent a sub-population at increased risk of recurrences. Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p = 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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