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Long‐term predictors of residual or recurrent cervical intraepithelial neoplasia 2‐3 after treatment with a large loop excision of the transformation zone: a retrospective study
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Objective: To assess the long-term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2–3) and time to recurrence after large loop excision of the transformation zone (LLETZ). Design: Retrospective study. Setting: Colposcopy clinic. Population: 242 women with CIN 2–3 treated between 1996 and 2006 and followed up until June 2016. Methods: Age, margins and high risk-human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan-Meier analysis. Main Outcome measure: Histologically confirmed CIN 2-3, HR-HPV, margins, age. Results: CIN 2-3 was associated with HR-HPV (HR =30.5; 95% CI =3.80-246.20); age >35 years (HR =5.53; 95% CI =1.22-25.13); and margins (HR = 7.31; 95% CI = 1.60–33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto(+)/endocervical(+)(16.7%), uncertain (19.4%) and ecto(-)/endocervical(+) margins (9.1%) showed a higher risk of recurrence (OR = 13.20(95% CI =1.02-170.96), 15.84(95% CI =3.02-83.01), and 6.60(95% CI =0.88-49.53)), respectively. Women with involved margins and/or HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log rank<0.001). Conclusions: HR-HPV and margins seem essential for stratifying post- LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women in order to reduce the risk. Funding statement: This study has received no funding.
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FERNÁNDEZ MONTOLÍ, Ma. eulalia, TOUS, Sara, MEDINA, Gonzalo, CASTELLANAU, Marta, GARCÍA TEJEDOR, María amparo, SANJOSÉ LLONGUERAS, Silvia de. Long‐term predictors of residual or recurrent cervical intraepithelial neoplasia 2‐3 after treatment with a large loop excision of the transformation zone: a retrospective study. _BJOG: An International Journal of Obstetrics & Gynaecology_. 2019. Vol. 127, núm. 3, pàgs. 377-387. [consulta: 25 de febrer de 2026]. [Disponible a: https://hdl.handle.net/2445/151519]