Recurrent high-grade squamous intraepithelial lesion and early-stage cervical cancer (in situ): predictors, long-term treatment outcomes, and opportunities for treatment and prevention

Background. The incidence of recurrent cervical dysplasia and early-stage cervical cancer varies between 2 % and 34 % depending on risk factors; thus, treatment and prevention strategies should be chosen individually. Constantly high incidence of cervical cancer and its recurrence necessitates improved preventive measures.

Aim. To identify predictors of intracervical recurrence of high-grade squamous intraepithelial lesion (HSIL) and earlystage cervical cancer using multivariate analysis in order to improve treatment strategies for newly diagnosed HSIL patients and patients with recurrent HSIL.

Materials and methods. This retrospective multicenter study included 322 patients newly diagnosed with HSIL (n = 300) and early-stage cervical cancer (n = 22), as well as patients with recurrent HSIL. The study was conducted at E.N. Meshalkin National Medical Research Center, Novosibirsk Regional Clinical Oncology Dispensary, Federal Research and Clinical Center for Specialized Medical Care and Medical Technologies of Federal Biomedical Agency of the Russian Federation, Siberian Center of Oncology and Gynecology “AvisMed” LLC, and “Zdorovye” LLC between 2011 and 2924.

All new patients with HSIL or cervical cancer in situ underwent loop radio-wave excision (conization) of the cervix and endocervical curettage. All patients were followed up after this procedure.

After histological examination patients tested positive for human papillomavirus (HPV) with a high recurrence risk were recommended antiviral therapy. Patients were divided into four groups according to the type of their treatment: 1) radio-wave conization of the cervix alone (control group); 2) radio-wave conization of the cervix in combination with laser photodynamic therapy of the cervix; 3) radio-wave conization of the cervix in combination with HPV quadrivalent vaccine; 4) radio-wave conization of the cervix in combination with Cervicon-DIM therapy. Patients with recurrent HSIL also had immunohistochemical or immunocytochemical assessment of p16 and Ki-67 coexpression.

Conclusion. Our study demonstrated the importance of identifying risk factors for recurrence and assessment of p16 and Ki-67 expression. The most significant risk factors included age over 36 years, positive resection margin, and involvement of endocervical crypts. Combination therapy with cervical conization plus local antiviral therapy with Cervicon-DIM was found to be most effective. Endocervical curettage using an endocervical resector can be used for the early diagnosis of HSIL and early-stage cervical cancer.

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