Journal Article

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Pinelli, Ciro, Scambia, Giovanni, Contino, Biagio, De Vincenzo, Rosa, Dell’Acqua, Andrea, Salerno, Maria Giovanna, Spinillo, Arsenio, Santangelo, Giusi, D’Ippolito, Giovanni, Sopracordevole, Francesco, Plotti, Francesco, Vercellini, Paolo, Simoncini, Tommaso, Monti, Ermelinda, Carlea, Annunziata, Aguzzoli, Lorenzo, Borghi, Chiara, Fischetti, Margherita, Liberale, Viola, Bergamini, Alice, Di Donato, Violante, Dondi, Giulia, Zullo, Fulvio, Ciavattini, Andrea, Petrillo, Marco, De Iaco, Pierandrea, Greggi, Stefano, Muzii, Ludovico, Dessiole, Salvatore, Zannoni, Gian Franco, Cianci, Stefano, Tinelli, Raffaele, Ferrandina, Gabriella, Ferrero, Simone, Matarazzo, Maria G., Donfrancesco, Cristina, Cianci, Antonio, Perrone, Anna Myriam, Sarpietro, Giuseppe, Mosca, Lavinia, Angioli, Roberto, Gardella, Barbara, Benedetti Panici, Pierluigi, Falcone, Francesca, Ghelardi, Alessandro, Giannella, Luca, Fracassi, Alice, Scaffa, Cono, Perniola, Giorgia, Capobianco, Giampiero, Serati, Maurizio, Palaia, Innocenza, Ruisi, Simona, Bosio, Sara, Palomba, Stefano, Muschiato, Barbara, Lalli, Luca, Mandato, Vincenzo Dario, Cas

2022

Overview

Background: Cervical dysplasia persistence/recurrence has a great impact on women’s health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18–89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5–52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.

• Publisher: MDPI AG,MDPI
• Subject: Cervical cancer / cervical dysplasia / Cervix / conization / Dysplasia / HPV / Human papillomavirus / Hysterectomy / Infections / LEEP / Mathematical functions / Medical prognosis / Nomograms / Patients / Quality of life / recurrence / Risk assessment / Risk management / Risk reduction / Software / Surgeons / Surgical techniques / Vaccination / Variables / Womens health