Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3)): a population-based study

E. Codde, A Munro, Colin J. Stewart, K. Spilsbury, S Bowen, J. Codde, N. Steel, Yee Leung, Jason Tan, Stuart G. Salfinger, Ganendra Mohan, Paul A. Cohen

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    Abstract

    OBJECTIVE: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.

    DESIGN: Retrospective cohort study.

    SETTING: Statewide population in Western Australia.

    POPULATION: Women diagnosed with AIS between 2001 and 2012.

    METHODS: We conducted a retrospective, population-based cohort study.

    MAIN OUTCOME MEASURES: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.

    RESULTS: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.

    CONCLUSION: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.

    TWEETABLE ABSTRACT: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.

    Original languageEnglish
    Pages (from-to)74-79
    JournalBJOG : an international journal of obstetrics and gynaecology
    DOIs
    Publication statusPublished - Jan 2018

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    Population
    Neoplasms
    Recurrence
    Adenocarcinoma in Situ
    Cohort Studies
    Western Australia
    Adenocarcinoma
    Retrospective Studies
    Incidence

    Cite this

    @article{7f0fc17cf5c9462d87f7e9dcdf1c43cc,
    title = "Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3)): a population-based study",
    abstract = "OBJECTIVE: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.DESIGN: Retrospective cohort study.SETTING: Statewide population in Western Australia.POPULATION: Women diagnosed with AIS between 2001 and 2012.METHODS: We conducted a retrospective, population-based cohort study.MAIN OUTCOME MEASURES: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.RESULTS: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8{\%}) had pure AIS and 370 (58.2{\%}) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4{\%}) had AIS persistence/recurrence and 12 (1.9{\%}) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95{\%}CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95{\%}CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95{\%}CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95{\%}CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.CONCLUSION: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.TWEETABLE ABSTRACT: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.",
    keywords = "Journal Article",
    author = "E. Codde and A Munro and Stewart, {Colin J.} and K. Spilsbury and S Bowen and J. Codde and N. Steel and Yee Leung and Jason Tan and Salfinger, {Stuart G.} and Ganendra Mohan and Cohen, {Paul A.}",
    note = "{\circledC} 2017 Royal College of Obstetricians and Gynaecologists.",
    year = "2018",
    month = "1",
    doi = "10.1111/1471-0528.14808",
    language = "English",
    pages = "74--79",
    journal = "BJOG: an International Journal of Obstetrics and Gynecology",
    issn = "1470-0328",
    publisher = "John Wiley & Sons",

    }

    TY - JOUR

    T1 - Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3))

    T2 - a population-based study

    AU - Codde, E.

    AU - Munro, A

    AU - Stewart, Colin J.

    AU - Spilsbury, K.

    AU - Bowen, S

    AU - Codde, J.

    AU - Steel, N.

    AU - Leung, Yee

    AU - Tan, Jason

    AU - Salfinger, Stuart G.

    AU - Mohan, Ganendra

    AU - Cohen, Paul A.

    N1 - © 2017 Royal College of Obstetricians and Gynaecologists.

    PY - 2018/1

    Y1 - 2018/1

    N2 - OBJECTIVE: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.DESIGN: Retrospective cohort study.SETTING: Statewide population in Western Australia.POPULATION: Women diagnosed with AIS between 2001 and 2012.METHODS: We conducted a retrospective, population-based cohort study.MAIN OUTCOME MEASURES: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.RESULTS: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.CONCLUSION: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.TWEETABLE ABSTRACT: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.

    AB - OBJECTIVE: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.DESIGN: Retrospective cohort study.SETTING: Statewide population in Western Australia.POPULATION: Women diagnosed with AIS between 2001 and 2012.METHODS: We conducted a retrospective, population-based cohort study.MAIN OUTCOME MEASURES: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.RESULTS: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.CONCLUSION: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.TWEETABLE ABSTRACT: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.

    KW - Journal Article

    U2 - 10.1111/1471-0528.14808

    DO - 10.1111/1471-0528.14808

    M3 - Article

    SP - 74

    EP - 79

    JO - BJOG: an International Journal of Obstetrics and Gynecology

    JF - BJOG: an International Journal of Obstetrics and Gynecology

    SN - 1470-0328

    ER -