Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment

Abstract

ObjectiveThis study aimed to investigate the clinicopathologic risk factors for type-specific persistence of high-risk humanpapillomavirus (hrHPV) and residual/recurrent cervical intraepithelial neoplasia (CIN) after surgical treatment. MethodsPatients with CIN-2/3 who underwent conization or loop electrosurgical excision procedure (LEEP) at Korea UniversityHospital were enrolled. All patients underwent hrHPV testing and genotyping before conization or LEEP followed byboth hrHPV genotyping and cytology. The significance of associations between patient characteristics and persistenceof infection were assessed by multivariate logistic regression analyses. ResultsAmong 398 women with pathologically confirmed CIN-2/3, 154 (38.7%) patients showed hrHPV persistence aftersurgical treatment. In multivariate analysis, high preoperative hrHPV load (P<0.05; odds ratio [OR], 2.063), presenceof CIN-2 at treatment (P<0.01; OR, 2.732), and multiple hrHPV infections (P<0.001; OR, 4.752) were associated withhrHPV persistence. HPV 53 was the most likely to persist after treatment (24/43, 55.8%). The risk of residual/recurrentCIN-2/3 was higher in persistent infection with HPV 16 than other types (P<0.05). Menopause (P<0.001; OR, 3.969),preoperative and postoperative hrHPV load (P<0.05; OR, 2.430; P<0.05; OR, 5.351), and infection with multiple hrHPVtypes (P<0.05; OR, 2.345) were significantly related to residual/recurrent CIN following surgical treatment. ConclusionHPV load before treatment and infection with multiple hrHPV types were predictors of postoperative hrHPVpersistence. HPV 53 was the type most likely to persist, but HPV 16 was the type that was most closely associated withresidual/recurrent CIN-2/3.