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. 2022 Apr 9;10(4):579.
doi: 10.3390/vaccines10040579.

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Giorgio Bogani  1 , Luca Lalli  2 , Francesco Sopracordevole  3 , Andrea Ciavattini  4 , Alessandro Ghelardi  5 , Tommaso Simoncini  6 , Francesco Plotti  7 , Jvan Casarin  8 , Maurizio Serati  8 , Ciro Pinelli  9 , Alice Bergamini  10 , Barbara Gardella  11 , Andrea Dell'Acqua  12 , Ermelinda Monti  12 , Paolo Vercellini  12 , Innocenza Palaia  1 , Giorgia Perniola  1 , Margherita Fischetti  1 , Giusi Santangelo  1 , Alice Fracassi  1 , Giovanni D'Ippolito  13 , Lorenzo Aguzzoli  13 , Vincenzo Dario Mandato  13 , Luca Giannella  4 , Cono Scaffa  14 , Francesca Falcone  14 , Chiara Borghi  15 , Mario Malzoni  16 , Andrea Giannini  1   17 , Maria Giovanna Salerno  17 , Viola Liberale  18 , Biagio Contino  18 , Cristina Donfrancesco  19 , Michele Desiato  19 , Anna Myriam Perrone  20 , Giulia Dondi  20 , Pierandrea De Iaco  20 , Simone Ferrero  21   22 , Giuseppe Sarpietro  23 , Maria G Matarazzo  23 , Antonio Cianci  23 , Stefano Cianci  24 , Sara Bosio  25 , Simona Ruisi  25 , Lavinia Mosca  26 , Raffaele Tinelli  27 , Rosa De Vincenzo  28 , Gian Franco Zannoni  28 , Gabriella Ferrandina  28 , Marco Petrillo  29 , Giampiero Capobianco  29 , Salvatore Dessiole  29 , Annunziata Carlea  30 , Fulvio Zullo  30 , Barbara Muschiato  31 , Stefano Palomba  32 , Stefano Greggi  14 , Arsenio Spinillo  11 , Fabio Ghezzi  8   9 , Nicola Colacurci  26 , Roberto Angioli  7 , Pierluigi Benedetti Panici  1 , Ludovico Muzii  1 , Giovanni Scambia  28 , Francesco Raspagliesi  2 , Violante Di Donato  1
Affiliations

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Giorgio Bogani et al. Vaccines (Basel). .

Abstract

Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.

Keywords: HPV; LEEP; cervical dysplasia; conization; recurrence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Five-year recurrence-free survival after primary conization.
Figure 2
Figure 2
Five-year recurrence-free survival according to margin status.
Figure 3
Figure 3
Nomogram assessing the risk of cervical dysplasia persistence/recurrence.
See this image and copyright information in PMC

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