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

Abstract

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.