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Article

Human Papillomavirus Same Genotype Persistence and Risk of Cervical Intraepithelial Neoplasia2+ Recurrence

1
Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
2
Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
3
Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, 20141 Milan, Italy
4
Bianalisi Laboratory, 20841 Carate Brianza, Italy
5
Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20141 Milan, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Gennaro Cormio
Cancers 2021, 13(15), 3664; https://doi.org/10.3390/cancers13153664
Received: 21 June 2021 / Revised: 17 July 2021 / Accepted: 18 July 2021 / Published: 21 July 2021
(This article belongs to the Special Issue Cervical Carcinoma)
Women diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and treated by excisional procedures remain at high risk for recurrence over time. “Treatment failure” has been reported in up to 23% of women within two years after treatment. The aim of this study was to investigate the impact of HPV same genotype persistence on CIN2+ recurrence. Our findings confirm that HPV same genotype persistence has 30-fold increased odds of developing CIN2+ recurrence (p < 0.001), whereas histological grade, glandular crypt involvement, and margin status are not significantly related with treatment failure. Persistence of multiple genotypes and of HPV 16/18 with or without other HR genotypes show a significant impact on relapse free survival. HPV genotyping as “test-of-cure” enables a personalized risk-based management, by identifying women at higher risk of relapse who need intensive follow-up and avoiding risk of over-treatment in women with new HPV genotype infection after surgery.
To evaluate the significance of HPV persistence as a predictor for the development of CIN2+ recurrence and the impact of multiple genotypes and of HPV 16/18 on recurrence risk. A prospective cohort observational study was carried out at the European Institute of Oncology, Milan, Italy, from December 2006 to December 2014. A total of 408 women surgically treated by excisional procedure for pre-neoplastic and neoplastic cervical lesions were enrolled. HPV test was performed at baseline and at first follow-up visit planned at 6 ± 3 months after treatment. Two-year cumulative incidences for relapse were estimated and compared by the Gray’s test. Overall, 96 (23.5%) patients were persistent for at least one genotype at three to nine months from baseline and 21 (5.1%) patients relapsed. The two-year cumulative relapse incidence was higher in HPV persistent patients compared to not-persistent (CIF = 27.6%, 95% CI: 16.2–40.2% versus CIF = 1.7%, 95% CI: 0.3–5.8%, p < 0.001), in women with persistent multiple infections (CIF = 27.2%, 95% CI: 7.3–52.3%, p < 0.001), and with the persistence of at least one genotype between 16 and 18, irrespective of the presence of other HR genotypes (CIF = 32.7%, 95% CI: 17.9–48.3%, p < 0.001), but not significantly different from women positive for single infections or any other HR genotype, but not for 16 and 18. The risk of CIN2+ recurrence should not be underestimated when same HPV genotype infection persists after treatment. View Full-Text
Keywords: CIN2+ recurrence; HPV persistence; HPV genotyping; High-Risk genotypes; multiple HPV infections; HPV 16/18; treatment failure; test-of-cure CIN2+ recurrence; HPV persistence; HPV genotyping; High-Risk genotypes; multiple HPV infections; HPV 16/18; treatment failure; test-of-cure
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MDPI and ACS Style

Iacobone, A.D.; Radice, D.; Sandri, M.T.; Preti, E.P.; Guerrieri, M.E.; Vidal Urbinati, A.M.; Pino, I.; Franchi, D.; Passerini, R.; Bottari, F. Human Papillomavirus Same Genotype Persistence and Risk of Cervical Intraepithelial Neoplasia2+ Recurrence. Cancers 2021, 13, 3664. https://doi.org/10.3390/cancers13153664

AMA Style

Iacobone AD, Radice D, Sandri MT, Preti EP, Guerrieri ME, Vidal Urbinati AM, Pino I, Franchi D, Passerini R, Bottari F. Human Papillomavirus Same Genotype Persistence and Risk of Cervical Intraepithelial Neoplasia2+ Recurrence. Cancers. 2021; 13(15):3664. https://doi.org/10.3390/cancers13153664

Chicago/Turabian Style

Iacobone, Anna D., Davide Radice, Maria T. Sandri, Eleonora P. Preti, Maria E. Guerrieri, Ailyn M. Vidal Urbinati, Ida Pino, Dorella Franchi, Rita Passerini, and Fabio Bottari. 2021. "Human Papillomavirus Same Genotype Persistence and Risk of Cervical Intraepithelial Neoplasia2+ Recurrence" Cancers 13, no. 15: 3664. https://doi.org/10.3390/cancers13153664

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