Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study

OBJECTIVE: To evaluate the risk factors potentially involved in the development
of cervical intraepithelial neoplasia (CIN) recurrence after cervical conization
in a long-term follow-up period. STUDY DESIGN: Consecutive patients with
histologically proven CIN who had undergone either cold knife conization or a
loop electrosurgical excision procedure were enrolled and scheduled for serial
follow-up examinations over a 10-year period. Data were stored in a digital
database. Multivariate analysis was performed to identify factors for recurrence.
RESULTS: Between January 1999 and December 2009, 282 patients fulfilled the
inclusion criteria and were included in the final statistical analysis. After a
median follow-up of 26.7months (range 6-100), 64 (22.7%) women developed
histologically confirmed recurrence. The 2-year recurrence-free survival was
83.7% and 66.7% for women with negative and positive margins, respectively
(p=0.008). The 5-year recurrence-free survival was 75.4% and 50.3% for patients
with negative and positive margins, respectively (p=0.0004). Positive surgical
margin was the most important independent predictor of recurrence [HR 2.5 (95%CI
1.5-4.5), p=0.0007; Wald 11.338]. After multinomial logistic regression the
indication for conization based on persistent CIN1 was the only independent
predictor for negative margin [OR 0.3 (95%CI 0.1-0.7), p=0.008]. CONCLUSIONS: Our
study demonstrated that the surgical margin status represents the most important
predictor for CIN recurrence after conization. After excisional therapy, close
follow-up is mandatory for the early detection of recurrent disease. The
identification of risk factors for recurrence may guide clinical decision-making
on expectant management versus re-intervention