Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia
Abstract
Objective
To evaluate the risk factors of recurrent high‐grade cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after loop electrosurgical excision procedure (LEEP).
Methods
This retrospective study included patients with histopathologically confirmed CIN2/3 who underwent LEEP in 2015–2020. Cox regression analysis was used to evaluate the risk factors of recurrence.
Results
Recurrent CIN2+ was found in 268 patients after LEEP (268/4369, recurrence rate, 6.1%). High‐risk (hr‐) HPV infection (hazard ratio [HR] 12.09, 95% confidence interval [CI] 7.78–18.79), margin status (HR 6.48, 95% CI 4.75–8.84), baseline diagnosis (HR 1.45, 95% CI 1.08–1.95), smoking (HR 3.17, 95% CI 2.27–4.43), and immunosuppression (HR 1.96, 95% CI 1.33–2.91) were significant independent risk factors of recurrence. HPV16 (HR 3.61, 95% CI 2.43–5.37), HPV33 (HR 2.62, 95% CI 1.12–6.12), and HPV52 (HR 1.61, 95% CI 1.02–2.55) infection showed a higher risk of recurrence. High‐risk HPV had the highest accuracy (sensitivity 88.5%; negative predictive values 98.7%) in predicting recurrence compared with liquid‐based cytology test and margins.
Conclusion
Given that positive margins present a higher risk, wide excision may be required to avoid residual lesions. More attention should be paid to the correlation between recurrence and hr‐HPV genotypes. After treatment for high‐grade CIN, HPV‐based testing is recommended at 6 months. Timely identification of high‐risk factors enables risk stratification, and enables individual management or individual follow‐up and recall strategies.