Objective: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia. Methods: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models. Results: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups. Conclusions: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness.

LASER treatment for women with high-grade vaginal intraepithelial neoplasia: a propensity-matched analysis on the efficacy of ablative versus excisional procedures / Bogani, G; Ditto, A; Martinelli, F; Mosca, L; Chiappa, V; Rossetti, D; Leone Roberti Maggiore, U; Sabatucci, I; Lorusso, D; Raspagliesi, F.. - In: LASERS IN SURGERY AND MEDICINE. - ISSN 0196-8092. - 50:9(2018), pp. 933-939. [10.1002/lsm.22941]

LASER treatment for women with high-grade vaginal intraepithelial neoplasia: a propensity-matched analysis on the efficacy of ablative versus excisional procedures

Bogani G
;
2018

Abstract

Objective: To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia. Methods: Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models. Results: Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups. Conclusions: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness.
2018
HPV; LASER; VaIN; high-grade vaginal intra-epithelial neoplasia
01 Pubblicazione su rivista::01a Articolo in rivista
LASER treatment for women with high-grade vaginal intraepithelial neoplasia: a propensity-matched analysis on the efficacy of ablative versus excisional procedures / Bogani, G; Ditto, A; Martinelli, F; Mosca, L; Chiappa, V; Rossetti, D; Leone Roberti Maggiore, U; Sabatucci, I; Lorusso, D; Raspagliesi, F.. - In: LASERS IN SURGERY AND MEDICINE. - ISSN 0196-8092. - 50:9(2018), pp. 933-939. [10.1002/lsm.22941]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1584137
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