Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up

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dc.contributor.authorAndrade, Carlos E. M. C.
dc.contributor.authorScapulatempo-Neto, Cristovam
dc.contributor.authorLongatto-Filho, Adhemar
dc.contributor.authorVieira, Marcelo A.
dc.contributor.authorTsunoda, Audrey T.
dc.contributor.authorSilva, Ismael D. C. G. da [UNIFESP]
dc.contributor.authorFregnani, Jose Humberto T. G.
dc.contributor.institutionBarretos Canc Hosp Pio XII Fdn
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:37:50Z
dc.date.available2016-01-24T14:37:50Z
dc.date.issued2014-09-01
dc.description.abstractObjective. 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.en
dc.description.affiliationBarretos Canc Hosp Pio XII Fdn, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo UNIFESP, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo UNIFESP, EPM, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipIDFAPESP: 2011/19749-6
dc.format.extent941-948
dc.identifierhttp://dx.doi.org/10.1111/aogs.12446
dc.identifier.citationActa Obstetricia Et Gynecologica Scandinavica. Hoboken: Wiley-Blackwell, v. 93, n. 9, p. 941-948, 2014.
dc.identifier.doi10.1111/aogs.12446
dc.identifier.issn0001-6349
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/38191
dc.identifier.wosWOS:000340618400016
dc.language.isoeng
dc.publisherWiley-Blackwell
dc.relation.ispartofActa Obstetricia Et Gynecologica Scandinavica
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://olabout.wiley.com/WileyCDA/Section/id-406071.html
dc.subjectCervical intraepithelial neoplasiaen
dc.subjectHPV DNA testsen
dc.subjectprognosisen
dc.subjectrecurrenceen
dc.subjectconizationen
dc.subjecthuman papillomavirusen
dc.titlePrognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-upen
dc.typeinfo:eu-repo/semantics/article
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