Influence of cervical treatment methods on subsequent vaginal lesions: A study of HPV-related neoplasia

Abstract

The development of cervical and vaginal intraepithelial neoplasias (CIN and VaIN) is strongly associated with human papillomavirus (HPV) infections, representing key precancerous conditions in women. This study investigates the influence of different cervical treatment methods on the rate of subsequent vaginal neoplasia. It also considers age and menopausal status as risk factors for higher-grade VaIN and the role of persistent HPV infections in the development of new VaIN cases post-treatment. The cohort consisted of 275 female patients treated for CIN, with a follow-up period of six months including HPV and ThinPrep cytologic test (TCT) testing. The evaluated treatments included laser therapy, cervical conization, loop electrosurgical excision procedure (LEEP), and radical hysterectomy. Statistical analysis was performed using SPSS 26.0 to determine treatment efficacy, the impact of age and menopausal status, and the relationship between HPV clearance and VaIN outcomes. Radical hysterectomy was linked with a higher recurrence of VaIN. Additionally, patients over 50 years old and those who were postmenopausal were significantly more likely to develop more severe VaIN and persistent HPV infections. Persistence of HPV after treatment was linked to a higher incidence of new VaIN cases. High-risk HPV significantly increased the recurrence of VaIN, with no significant link found between TCT results and VaIN severity. Therefore, selecting appropriate cervical lesion treatment, considering the patient's age and menopausal status, and managing HPV infections are essential in preventing and managing the risk and progression of VaIN. Radical hysterectomy showed a distinct increase in VaIN incidence, emphasizing the need for individualized clinical assessments.

Figure 1.

Incidence of vaginal lesions post-cervical lesion treatment. This figure illustrates the incidence of VaIN following CIN treatment, including the distribution of VaIN1+, as well as cases of patients with vaginal viral infection (A), LSIL (B), and HSIL (C). VaIN: Vaginal intraepithelial neoplasia; CIN: Cervical intraepithelial neoplasia; LSIL: Low-grade squamous intraepithelial lesion; HSIL: High-grade squamous intraepithelial lesion.

Figure 2.

Comparison of VaIN detection rates after treatment of cervical lesions, highlighting the effectiveness of different therapeutic approaches. VaIN: Vaginal intraepithelial neoplasia; LEEP: Loop electrosurgical excision procedure.

Figure 3.

Age distribution of patients with different categories of VaIN, providing insight into the prevalence and risk factors across various age groups. VaIN: Vaginal intraepithelial neoplasia; LSIL: Low-grade squamous intraepithelial lesion; HSIL: High-grade squamous intraepithelial lesion.

Figure 4.

Comparative analysis of the incidence of VaIN and viral infections in postmenopausal women. This figure compares the incidence rates of VaIN and viral infections between postmenopausal and premenopausal women; ***P < 0.001. VaIN: Vaginal intraepithelial neoplasia; LSIL: Low-grade squamous intraepithelial lesion; ≥HSIL: High-grade squamous intraepithelial lesion and more severe lesions.

Figure 5.

Analysis of the relationship between HPV clearance status post-cervical lesion treatment and the risk of new VaIN occurrences. This figure illustrates the association between HPV clearance status post-treatment of cervical lesions and the risk of new VaIN occurrences; *P < 0.05. VaIN: Vaginal intraepithelial neoplasia; HPV: Human papillomavirus; LSIL: Low-grade squamous intraepithelial lesion; ≥HSIL: High-grade squamous intraepithelial lesion and more severe lesions.

Figure 6.

Analysis of the association between cervical lesion grade and the risk of recurrence of new VaIN occurrences. This figure compares the risk of new VaIN occurrences recurrence post-treatment among patients with different grades of cervical lesions, including analyses for CIN1, CIN2, CIN3, and CA patients; ^#P > 0.05. VaIN: Vaginal intraepithelial neoplasia; CIN: Cervical intraepithelial neoplasia; LSIL: Low-grade squamous intraepithelial lesion; ≥HSIL: High-grade squamous intraepithelial lesion and more severe lesions; CA: Cervical cancer.

Figure 7.

Distribution of HPV types in female vaginal epithelial lesions. HPV: Human papillomavirus.

Figure 8.

Correlations in VaIN: treatment approaches, age, menopausal status, and HPV infections. VaIN: Vaginal intraepithelial neoplasia; HPV: Human papillomavirus; TCT: ThinPrep cytologic test.

Figure 9.

A preliminary roadmap on preventing VaIN after a hysterectomy. VaIN: Vaginal intraepithelial neoplasia; HPV: Human papillomavirus.