In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes—Cervical Adenocarcinoma Study Group (CAS-Group)
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Independent Variables | n (%) (Sample Size = 148) |
---|---|
Age (years) (median and interquartile ranges) | 40.5 (34.0–49.0) |
Menopause | 26 (17.6) |
Nulligravid | 66 (44.6) |
Smoking habit | 38 (25.6) |
Vaccinated | 10 (6.8) |
Conization Type | |
CKC | 11 (7.4) |
Laser conization | 36 (24.3) |
LEEP | 101 (68.2) |
Cone length (mm) (median and interquartile ranges) | 16.5 (13.0–21.0) |
Pap Test | |
Negative | 5 (3.4) |
ASCUS/LSIL | 18 (12.2) |
ASCH+ | 94 (63.5) |
AGC-NOS | 19 (12.8) |
AGC-FN | 4 (2.7) |
AIS | 8 (5.4) |
Definitive Treatment | |
Fertility-sparing | 85 (57.4) |
Standard treatment | 63 (42.6) |
HPV status | |
Positive | 124 (83.8) |
Negative | 24 (16.2) |
Adnexa | |
Salpingo-oophorectomy | 41 (27.7) |
Salpingectomy | 15 (10.1) |
Not performed | 92 (62.2) |
Positive LVS | 16 (10.8) |
Stage | |
1A1 | 23 (15.5) |
1A2 | 21 (14.2) |
AIS | 104 (70.3) |
Histopatology | |
Clear cell | 1 (0.7) |
Endometrioid | 1 (0.7) |
Gastric type | 1 (0.7) |
Serous | 1 (0.7) |
Signet ring cell | 1 (0.7) |
Intestinal type | 10 (6.8) |
Mucinous-NOS | 5 (3.4) |
Usual type | 120 (81.1) |
Villoglandular | 8 (5.4) |
Positive hr-HPV in follow-up | 29 (19.6) |
Positive Pap test in follow-up | |
ASCUS/LSIL | 5 (3.4) |
ASCH+ | 7 (4.7) |
Recurrence | |
AIS | 4 (2.7) |
VAIN 2/3 | 2 (1.3) |
CIN 3 | 1 (0.7) |
Invasive glandular | 3 (2.0) |
Invasive squamous | 1 (0.7) |
Time to recurrence (mean ± standard deviation, months) | 33.0 ± 22.9 |
Time to HPV positivity (mean ± standard deviation, months) | 26.4 ± 18.9 |
Independent Variables | HPV-Positive (124) n (%) | HPV-Negative (24) n (%) | p Value |
---|---|---|---|
Age (median and interquartile ranges, years) | 39.5 (34.0–48.0) | 47 (35.5–56.5) | 0.032 |
Menopause | 18 (14.5) | 8 (33.3) | 0.027 |
Nulligravid | 59 (47.6) | 7 (29.2) | 0.098 |
Smoking habit | 29 (23.4) | 9 (37.5) | 0.148 |
Vaccinated | 10 (8.1) | 0 (0.0) | 0.151 |
Conization Type | 0.425 | ||
CKC | 8 (6.5) | 3 (12.5) | |
Laser C | 32 (25.8) | 4 (16.7) | |
LEEP | 84 (67.7) | 17 (70.8) | |
Cone length (median and interquartile ranges, mm) | 16.5 (13.0–20.5) | 16.5 (15.0–25.0) | 0.485 |
Pap Test | 0.336 | ||
Negative | 3 (2.4) | 2 (8.3) | |
ASCUS/LSIL | 15 (12.1) | 3 (12.5) | |
ASCH+ | 106 (85.5) | 19 (79.2) | |
Definitive Treatment | 0.089 | ||
Fertility-sparing | 75 (60.5) | 10 (41.7) | |
Standard treatment | 49 (39.5) | 14 (58.3) | |
Adnexa | 0.094 | ||
Salpingo-oophorectomy | 30 (24.2) | 11 (45.8) | |
Salpingectomy | 13 (10.5) | 2 (8.3) | |
Positive LVS | 9 (7.3) | 7 (29.2) | 0.001 |
Stage | 0.642 | ||
1A1 | 18 (14.5) | 5 (20.8) | |
1A2 | 17 (13.7) | 4 (16.7) | |
AIS | 89 (71.8) | 15 (62.5) | |
Histopatology | 0.049 | ||
Usual type | 104 (83.9) | 16 (66.7) | |
Other histology type | 20 (16.1) | 8 (33.3) | |
Positive hr-HPV in follow-up | 28 (22.6) | 1 (4.2) | 0.038 |
Positive Pap test in follow-up | 0.415 | ||
ASCUS/LSIL | 5 (4.0) | 0 (0.0) | |
ASCH+ | 5 (4.0) | 2 (8.3) | |
Negative | 114 (91.9) | 22 (91.7) | |
Recurrence | 0.457 | ||
In situ disease | 5 (4.0) | 2 (8.3) | |
Invasive disease | 4 (3.2) | 0 (0.0) | |
No recurrence | 115 (92.8) | 22 (91.7) | |
Time to recurrence (mean ± standard deviation)—Months | 36.0 ± 23.0 | 19.5 ± 23.33 | 0.384 |
Predictor Variables | Coefficient b | Standard Error | Exp(b) | 95% CI of Exp(b) |
---|---|---|---|---|
Age | −0.084 | 0.051 | 0.91 | 0.83 to 1.01 |
Histopatology = other histology | 0.66 | 0.64 | 1.94 | 0.54 to 6.94 |
Menopause | - | - | - | - |
Lymphovascular space involvement = yes | 0.49 | 1.00 | 1.64 | 0.22 to 11.75 |
HPV test in follow-up = positive | 2.98 | 0.97 | 19.74 | 2.91 to 133.81 |
Definitive treatment = standard treatment | 0.77 | 0.74 | 2.17 | 0.50 to 9.34 |
HPV status = negative HPV | 1.71 | 1.18 | 5.56 | 0.54 to 57.01 |
Recurrence Type | HPV Genotypes n (%) | ||||
---|---|---|---|---|---|
HPV-16 | HPV-18 | HPV-45 | Other HPVs | Multiple Infections | |
No recurrence | 19 (28.4) | 15 (22.4) | 5 (7.5) | 8 (11.9) | 20 (29.9) |
In situ recurrence | 1 (20) | 3 (60) | 1 (20) | 0 (0.0) | 0 (0.0) |
Invasive recurrence | 1 (25) | 3 (75) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
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Giannella, L.; Delli Carpini, G.; Di Giuseppe, J.; Bogani, G.; Sopracordevole, F.; Clemente, N.; Giorda, G.; De Vincenzo, R.P.; Evangelista, M.T.; Gardella, B.; et al. In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes—Cervical Adenocarcinoma Study Group (CAS-Group). Cancers 2023, 15, 2876. https://doi.org/10.3390/cancers15112876
Giannella L, Delli Carpini G, Di Giuseppe J, Bogani G, Sopracordevole F, Clemente N, Giorda G, De Vincenzo RP, Evangelista MT, Gardella B, et al. In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes—Cervical Adenocarcinoma Study Group (CAS-Group). Cancers. 2023; 15(11):2876. https://doi.org/10.3390/cancers15112876
Chicago/Turabian StyleGiannella, Luca, Giovanni Delli Carpini, Jacopo Di Giuseppe, Giorgio Bogani, Francesco Sopracordevole, Nicolò Clemente, Giorgio Giorda, Rosa Pasqualina De Vincenzo, Maria Teresa Evangelista, Barbara Gardella, and et al. 2023. "In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes—Cervical Adenocarcinoma Study Group (CAS-Group)" Cancers 15, no. 11: 2876. https://doi.org/10.3390/cancers15112876