Predictors of Cervical Precancer Treatment Failure

Key Points

  • In women treated for cervical precancer, positive margins were associated with a significantly increased risk of residual or recurrent CIN2+.
  • Posttreatment high-risk HPV testing had greater sensitivity and similar specificity vs excision margin status.

In a meta-analysis reported in The Lancet Oncology, Arbyn et al found that posttreatment high-risk human papillomavirus (HPV) testing was a better predictor of recurrence of high-grade cervical intraepithelial neoplasia of grade 2 or higher (CIN2+) than incomplete cervical excision.

Study Details

The meta-analysis included 97 studies, from a literature search covering January 1975 to February 2016, representing a total of 44,446 women treated for cervical precancer. The studies were eligible if patients had undergone treatment by excision of a histologically confirmed CIN2+ lesion with verification of the presence or absence of cervical intraepithelial neoplasia at the resection, were tested by cytology or HPV assay between 3 months and 9 months after treatment, and had subsequent follow-up of at least 18 months posttreatment including histologic confirmation of the occurrence of CIN2+. Treatment failure associated with marginal status was defined as occurrence of residual or recurrent CIN2+.

Predictors of Residual or Recurrent CIN2+

Overall, positive margins were found in 23.1% of cases, with the proportions ranging from 17.8% with laser conization to 25.9% with large loop excision of the transformation zone, and the risk of positive margins increased according to the severity of the treated lesion. The overall risk of residual or recurrent CIN2+ was 6.6%; the risk was increased for positive vs negative margins (relative risk = 4.8, 95% confidence interval = 3.2–7.2). Sensitivity and specificity for predicting residual or recurrent CIN2+ were 55.8% and 84.4% for margin status and 91.0% and 83.8% for high-risk HPV testing, respectively. The risk of recurrent or residual CIN2+ was 0.8% with a negative posttreatment high-risk HPV test and 3.7% with negative margins.

The investigators concluded: “The risk of residual or recurrent CIN2+ is significantly greater with involved margins on excisional treatment; however, high-risk HPV post-treatment predicts treatment failure more accurately than margin status.”

The study was funded by the European Federation for Colposcopy and Institut National du Cancer.

Marc Arbyn, DrTM&H, of the Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, is the corresponding author of The Lancet Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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