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HPV testing as an effective triage strategy in the follow-up after fertility-sparing treatment for glandular lesions of the uterine cervix
  1. Lukas Dostalek1,
  2. Pavel Freitag1,
  3. Miroslava Slovackova2,
  4. Tomas Zima2,
  5. Martin Komarc3,
  6. Lenka Fricova1,
  7. Tomas Fucik1,
  8. Kristyna Nemejcova4,
  9. David Cibula1,
  10. Daniel Brynda1 and
  11. Jiri Slama1
  1. 1Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
  2. 2Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
  3. 3Institute of Biophysics and Informatics, First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
  4. 4Department of Pathology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
  1. Correspondence to Prof. Dr. Jiri Slama, Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic; Jiri.Slama{at}vfn.cz

Abstract

Objective The management and surveillance of glandular pre-cancerous lesions of the uterine cervix present distinct challenges compared with squamous lesions, primarily attributed to the lower effectiveness of diagnostic methods such as cytology or colposcopy. This study aimed to investigate the long-term safety of fertility-sparing treatment for adenocarcinoma in situ and microinvasive adenocarcinoma of the cervix, while identifying factors associated with recurrence, with a particular emphasis on the role of human papillomavirus (HPV) testing.

Methods We retrospectively reviewed data from all patients with histopathologically confirmed adenocarcinoma in situ or microinvasive cervical adenocarcinoma who received treatment at a single center between 2002 and 2023. The study involved the examination of consecutive surgical specimens and the follow-up details. Factors associated with recurrence were assessed in a subgroup of patients with available long-term follow-up data (at least 6 months).

Results In total, 143 patients (112 with adenocarcinoma in situ and 31 with adenocarcinoma) were included in the analysis. Among the 86 patients who underwent fertility-sparing treatment, the recurrence rate was 9% (12% for adenocarcinoma in situ and 4% for adenocarcinoma) during a median follow-up period of 56.6 months (range 7–179). No patients who were HPV negative experienced recurrence during the follow-up period. In contrast, among patients who were HPV positive, the recurrence rate was 38%. Additionally, HPV 16/18 positivity displayed a notable association with a higher risk of recurrence compared with the other high-risk genotypes, although this difference did not reach statistical significance (83% vs 10%; p=0.083, log-rank).

Conclusion Our retrospective study demonstrated a significant association between the risk of recurrence and HPV status during the follow-up period. Consequently, long-term follow-up utilizing HPV testing and genotyping appears to be a secure alternative to a hysterectomy.

  • Adenocarcinoma
  • Gynecologic Surgical Procedures
  • Uterine Cervical Neoplasms

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors LD: guarantor, study design, collected data, manuscript writing; PF: collected data; KN: pathology consultation, manuscript writing; DC: manuscript writing, scientific advisor; MS: collected data; TZ: collected data, scientific advisor; MK: statistics advisor; LF: collected data; TF: collected data; DB: collected data; JS: guarantor, manuscript writing, collected data, scientific advisor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.