| Autor: |
Andrade, Carlos E.M.C., Scapulatempo ‐ Neto, Cristovam, Longatto ‐ Filho, Adhemar, Vieira, Marcelo A., Tsunoda, Audrey T., Da Silva, Ismael D.C.G., Fregnani, José Humberto T.G. |
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| Zdroj: |
Acta Obstetricia et Gynecologica Scandinavica; Sep2014, Vol. 93 Issue 9, p941-948, 8p |
| Abstrakt: |
Objective To develop a prognostic model for women who underwent surgical treatment for cervical intraepithelial neoplasia. Design Cohort study. Patient inclusion and follow-up occurred retrospectively and prospectively. Setting Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Population Women ( n = 242) diagnosed with cervical intraepithelial neoplasia who were submitted to conization. Methods Immediately prior to surgical treatment, a cervical cytology sample was collected from each individual included in the study by endocervical brushing and stored in a preservative solution with methanol. A human papilloma virus- DNA test was conducted using an aliquot of the endocervical brushings. The surgical specimens were subjected to immunohistochemical analysis of p16 (immunohistochemical analysis 4a) protein expression. Main outcome measures Two-year disease-free survival rates calculated for each study variable. Identified variables in the multivariate Cox model were used for elaboration of prognostic scores. Results Variables associated with outcome included age ( p = 0.033), tobacco use ( p < 0.001), final histopathological diagnosis ( p = 0.007), surgical margins ( p < 0.001), high-risk human papilloma virus status ( p = 0.008), human papilloma virus-16 status ( p < 0.001) and immunoexpression of p16 in the cytoplasm ( p = 0.049). By the Cox model, independent risk factors for disease recurrence/persistence were: tobacco use (hazard risk = 3.0; 95% confidence interval 1.6-5.6), positive surgical margins (hazard risk = 3.2; 95% confidence interval 1.6-6.1), human papilloma virus-16 (hazard risk = 3.3; 95% confidence interval 1.6-6.9) and age over 45 years (hazard risk = 2.7; 95% confidence interval 1.1-6.6). Conclusions Establishment of a prognostic score can represent a valuable tool for determining the risk of cervical intraepithelial neoplasia recurrence after conization. The use of clinical (age and tobacco use), pathological (surgical margins) and molecular (human papilloma virus-16 genotyping) factors can facilitate more appropriate patient follow up according to risk stratification. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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