Study Results
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Basic Information
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COMPLETED
148 participants
OBSERVATIONAL
2022-06-30
2023-03-20
Brief Summary
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Prognostic Value of Conization and Negative HPV After Conization in AIS and Early Stage Cervical Cancer
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Detailed Description
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Most glandular cervical lesions occur at an early stage. The standard of treatment for in situ or micro-invasive lesions is extra fascial hysterectomy (AIS or stage 1A1 with no LVSI) or modified radical hysterectomy with pelvic lymph node dissection (stage 1A1 with LVSI, or 1A2). In fertility-sparing treatment, conization or radical trachelectomy with pelvic lymph node dissection is an option.
Another aspect that differentiates cervical adenocarcinoma from squamous lesions is the link with HPV infection. In 2018, the International Endocervical Criteria and Classification categorized cervical glandular lesions into HPV-associated and non-HPV-associated AC. Unlike cervical squamous lesions, which are almost all linked to high-risk HPV types, AC can be HPV negative in up to 15-20% of cases. The HPV 18 genotype is the most represented in AC with a rate of 38-50% in AIS and 50% in invasive stages. Based on some studies, it appears that non-HPV-related lesions have worse outcomes. This can significantly impact screening programs where 14 high-risk HPVs are tested.
In a recent study including 341 surgical specimens of AC, 100% of non-HPV-related lesions were classified as Silva Pattern C (the worst prognostic pattern). Instead, no impact of the HPV genotype was found on 113 women with AC during a follow-up of 5 years. HPV 45 showed a shorter 5-year survival than HPV 16 or 18.
While for advanced lesions, the stage itself represents the most important prognostic factor for prognosis, in situ or micro-invasive lesions may represent the best target for evaluating HPV status impact. This may be of interest as there is the option of conservative treatment in addition to standard treatment in early stages.
Conditions
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Study Design
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CASE_ONLY
RETROSPECTIVE
Study Groups
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Positive high-risk HPV
Women with adenocarcinoma of the uterine cervix and positive for high-risk HPV (genotype16/18/31/33/35/39/45/51/52/56/58/59/68).
Conization and/or Hysterectomy
Women undergoing cervical conization or simple/modified/radical hysterectomy with or without pelvic lymphadenectomy
Negative high-risk HPV
Women with adenocarcinoma of the uterine cervix and negative for high-risk HPV (genotype16/18/31/33/35/39/45/51/52/56/58/59/68).
Conization and/or Hysterectomy
Women undergoing cervical conization or simple/modified/radical hysterectomy with or without pelvic lymphadenectomy
Interventions
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Conization and/or Hysterectomy
Women undergoing cervical conization or simple/modified/radical hysterectomy with or without pelvic lymphadenectomy
Eligibility Criteria
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Inclusion Criteria
* Women with HPV testing within 2 months before conization.
* Women should be diagnosed and managed by the corresponding center.
* Patients with adequate clinical and pathological data.
Exclusion Criteria
* Women with immunological disease (e.g. HIV).
* Unavailable HPV testing before surgery.
* Women with inadequate follow-up.
25 Years
80 Years
FEMALE
No
Sponsors
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Università Politecnica delle Marche
OTHER
Responsible Party
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Luca Giannella
Principal Investigator
Locations
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Department of Gynecology and Obsetrics
Ancona, , Italy
Countries
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References
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Baalbergen A, Smedts F, Ewing P, Snijders PJ, Meijer CJ, Helmerhorst TJ. HPV-type has no impact on survival of patients with adenocarcinoma of the uterine cervix. Gynecol Oncol. 2013 Mar;128(3):530-4. doi: 10.1016/j.ygyno.2012.12.013. Epub 2012 Dec 19.
Liverani CA, Di Giuseppe J, Giannella L, Delli Carpini G, Ciavattini A. Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature. J Oncol. 2020 Nov 5;2020:8887672. doi: 10.1155/2020/8887672. eCollection 2020.
Ciavattini A, Giannella L, De Vincenzo R, Di Giuseppe J, Papiccio M, Lukic A, Delli Carpini G, Perino A, Frega A, Sopracordevole F, Barbero M, Gultekin M. HPV Vaccination: The Position Paper of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Vaccines (Basel). 2020 Jul 2;8(3):354. doi: 10.3390/vaccines8030354.
Park KJ. Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification. Histopathology. 2020 Jan;76(1):112-127. doi: 10.1111/his.13995.
Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 Sep;70(5):321-346. doi: 10.3322/caac.21628. Epub 2020 Jul 30.
Talaat A, Brinkmann D, Dhundee J, Hana Y, Bevan J, Irvine R, Bailey S, Woolas R. Risk of significant gynaecological pathology in women with glandular neoplasia on cervical cytology. Cytopathology. 2012 Dec;23(6):371-7. doi: 10.1111/j.1365-2303.2011.00891.x. Epub 2011 Jul 12.
Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Clark R, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Jan;17(1):64-84. doi: 10.6004/jnccn.2019.0001.
Teoh D, Musa F, Salani R, Huh W, Jimenez E. Diagnosis and Management of Adenocarcinoma in Situ: A Society of Gynecologic Oncology Evidence-Based Review and Recommendations. Obstet Gynecol. 2020 Apr;135(4):869-878. doi: 10.1097/AOG.0000000000003761.
Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, Aviel-Ronen S, Kiyokawa T, Alvarado-Cabrero I, Oliva E, Park KJ, Abu-Rustum NR, Pike MC, Soslow RA. Stromal invasion pattern identifies patients at lowest risk of lymph node metastasis in HPV-associated endocervical adenocarcinomas, but is irrelevant in adenocarcinomas unassociated with HPV. Gynecol Oncol. 2018 Jul;150(1):56-60. doi: 10.1016/j.ygyno.2018.04.570. Epub 2018 May 30.
Rositch AF, Soeters HM, Offutt-Powell TN, Wheeler BS, Taylor SM, Smith JS. The incidence of human papillomavirus infection following treatment for cervical neoplasia: a systematic review. Gynecol Oncol. 2014 Mar;132(3):767-79. doi: 10.1016/j.ygyno.2013.12.040. Epub 2014 Jan 7.
Perez S, Inarrea A, Perez-Tanoira R, Gil M, Lopez-Diez E, Valenzuela O, Porto M, Alberte-Lista L, Peteiro-Cancelo MA, Treinta A, Carballo R, Reboredo MC, Alvarez-Arguelles ME, Purrinos MJ. Fraction of high-grade cervical intraepithelial lesions attributable to genotypes targeted by a nonavalent HPV vaccine in Galicia, Spain. Virol J. 2017 Nov 6;14(1):214. doi: 10.1186/s12985-017-0879-1.
Other Identifiers
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AC-HPV2
Identifier Type: -
Identifier Source: org_study_id
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