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Title: Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up
Authors: Andrade, Carlos E. M. C.
Scapulatempo-Neto, Cristovam
Longatto-Filho, Adhemar
Vieira, Marcelo A.
Tsunoda, Audrey T.
Silva, Ismael D. C. G. da [UNIFESP]
Fregnani, Jose Humberto T. G.
Barretos Canc Hosp Pio XII Fdn
Universidade Federal de São Paulo (UNIFESP)
Keywords: Cervical intraepithelial neoplasia
HPV DNA tests
human papillomavirus
Issue Date: 1-Sep-2014
Publisher: Wiley-Blackwell
Citation: Acta Obstetricia Et Gynecologica Scandinavica. Hoboken: Wiley-Blackwell, v. 93, n. 9, p. 941-948, 2014.
Abstract: 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.
ISSN: 0001-6349
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