Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study

• Published in: BMC cancer Vol. 15; no. 1; p. 744
• Main Authors: Zhu, Menghan, He, Yuan, Baak, Jan PA, Zhou, Xianrong, Qu, Yuqing, Sui, Long, Feng, Weiwei, Wang, Qing
• Format: Journal Article
• Language: English
• Published: London BioMed Central 20.10.2015; BioMed Central Ltd
• Subjects: Adult; Aged; Biomedical and Life Sciences; Biomedicine; Biopsy; Cancer Research; Cellular biology; Cervical cancer; Electrosurgery - methods; Female; Follow-Up Studies; Gynecology; Health Promotion and Disease Prevention; Histology; Hospitals; Human papillomavirus; Humans; Hypotheses; Hysterectomy; Medicine/Public Health; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Obstetrics; Odds Ratio; Oncology; Patients; Research Article; Retrospective Studies; Risk Factors; Squamous Intraepithelial Lesions of the Cervix - epidemiology; Squamous Intraepithelial Lesions of the Cervix - pathology; Squamous Intraepithelial Lesions of the Cervix - surgery; Surgery; Surgical Oncology; Young Adult; Persistence; Recurrence; Positive margins; LEEP; HSIL; Follow-up
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-015-1748-1

Background In 5–20 % of patients with cervical high-grade squamous intraepithelial lesion (HSIL), a positive margin after the loop electrosurgical excision procedure (LEEP) is associated with persistence/recurrence, but the prognostic value of other clinico-pathological factors is less clear. Methods Among 4336 patients with HSIL who underwent an initial LEEP, 275 (6 %) had HSIL-positive margins, 37 of whom were lost to follow-up. We evaluated the remaining 238 patients. Persistence/recurrence was defined as histopathological HSIL during follow-up. Results The age of the patients ranged from 21 to 69 years (median: 40). The median follow-up period was 25 months (range: 6–43). Of the 238 patients, 211 (88.7 %) patients remained free of persistence/recurrence, while 27 (11.3 %) experienced persistence/recurrence. According to a univariate analysis, age ( P  = 0.03) and maximum specimen diameter ( P  = 0.043) were associated with persistence/recurrence, but number/location of involved margin sections and the pathology of the endocervical curettage were not ( P  > 0.10). The relative risk of the subjects (greater than or equal to 35 years ages) was 4.6 times of the subject less than 35 years, the difference was statistically significant (14 % vs. 3 %, P  < 0.05). A multivariate analysis indicated that an age of 35 years or older was the only independent risk factor (OR 4.97, 95 % CI 1.14–21.62, P  = 0.03). Conclusion In patients with HSIL and HSIL-involved margins after an initial LEEP, age is a strong independent predictor of persistence/recurrence. Follow-up with screening cytology and/or biopsy may be considered in younger patients, whereas a secondary LEEP/hysterectomy may be considered in older patients.