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Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia
OBJECTIVE: We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. METHODS: Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recur...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393627/ https://www.ncbi.nlm.nih.gov/pubmed/30740952 http://dx.doi.org/10.3802/jgo.2019.30.e20 |
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author | Bogani, Giorgio Ditto, Antonino Ferla, Stefano Paolini, Biagio Lombardo, Claudia Lorusso, Domenica Raspagliesi, Francesco |
author_facet | Bogani, Giorgio Ditto, Antonino Ferla, Stefano Paolini, Biagio Lombardo, Claudia Lorusso, Domenica Raspagliesi, Francesco |
author_sort | Bogani, Giorgio |
collection | PubMed |
description | OBJECTIVE: We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. METHODS: Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models. RESULTS: Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range,5-42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028). CONCLUSION: Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes. |
format | Online Article Text |
id | pubmed-6393627 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology |
record_format | MEDLINE/PubMed |
spelling | pubmed-63936272019-03-06 Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia Bogani, Giorgio Ditto, Antonino Ferla, Stefano Paolini, Biagio Lombardo, Claudia Lorusso, Domenica Raspagliesi, Francesco J Gynecol Oncol Original Article OBJECTIVE: We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. METHODS: Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models. RESULTS: Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range,5-42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028). CONCLUSION: Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes. Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 2018-11-08 /pmc/articles/PMC6393627/ /pubmed/30740952 http://dx.doi.org/10.3802/jgo.2019.30.e20 Text en Copyright © 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Bogani, Giorgio Ditto, Antonino Ferla, Stefano Paolini, Biagio Lombardo, Claudia Lorusso, Domenica Raspagliesi, Francesco Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title | Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title_full | Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title_fullStr | Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title_full_unstemmed | Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title_short | Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
title_sort | treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393627/ https://www.ncbi.nlm.nih.gov/pubmed/30740952 http://dx.doi.org/10.3802/jgo.2019.30.e20 |
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