Impact of human papillomavirus status before cervical conization on the clinical course of patients with cervical intraepithelial neoplasia

Persistent infection with human papillomavirus (HPV) is a key driver in the development of cervical cancer (CC). We aimed to elucidate the relationship between preoperative high-risk HPV status and prognosis of cervical intraepithelial neoplasia (CIN) in patients undergoing cervical conization. We retrospectively analyzed data from 2546 patients with CIN who underwent HPV deoxyribonucleic acid (DNA) testing and cervical conization in two individual years, i.e., 2009 and 2013, at 205 Japanese institutions. Patients were categorized into five groups based on their high-risk HPV status: high-risk HPV negative (Group 1); HPV 16/18 positive (Group 2); positive for HPV types 31, 33, 35, 45, 52 or 58 (Group 3); other high-risk HPV positive (Group 4); and unconfirmed high-risk HPV status (Group 5). Logistic and Cox regression analyses were conducted for statistical assessment. The distribution of participants across Groups 1 to 5 was 8.1%, 26.3%, 20.1%, 3.0% and 42.5%, respectively. Cervical conization identified CC in 3.9% (99 patients) of the cohort. Multivariate analysis revealed that diagnostic conization, preoperative diagnosis of CIN grade 3 and HPV 16/18 positivity were significant risk factors for post-conization CC. Notably, no correlation was found between preoperative HPV status and post-conization recurrence in patients without CC. HPV types 16 and 18 emerged as significant independent risk factors for CC development following conization. The study findings underscore the need for vigilant management of this patient group. However, the presence of high-risk HPV before conization was not correlated with the risk of recurrence.

Cervical intraepithelial neoplasia; Conization; Papillomaviridae; Papillomavirus infections; Risk factors

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