High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes

G. Bogani, F. Sopracordevole, V. Di Donato, A. Ciavattini, A. Ghelardi, S. Lopez, T. Simoncini, F. Plotti, J. Casarin, M. Serati, C. Pinelli, G. Valenti, A. Bergamini, B. Gardella, A. Dell'acqua, E. Monti, P. Vercellini, M. Fischetti, G. D'ippolito, L. AguzzoliV.D. Mandato, P. Carunchio, G. Carlinfante, L. Giannella, C. Scaffa, F. Falcone, C. Borghi, A. Ditto, M. Malzoni, A. Giannini, M.G. Salerno, V. Liberale, B. Contino, C. Donfrancesco, M. Desiato, A.M. Perrone, G. Dondi, P. De Iaco, V. Chiappa, S. Ferrero, G. Sarpietro, M.G. Matarazzo, A. Cianci, S. Bosio, S. Ruisi, R. Guerrisi, C. Brusadelli, L. Mosca, A.S. Lagana’, R. Tinelli, M. Signorelli, R. De Vincenzo, G.F. Zannoni, G. Ferrandina, S. Lovati, M. Petrillo, S. Dessole, A. Carlea, F. Zullo, R. Angioli, S. Greggi, A. Spinillo, F. Ghezzi, N. Colacurci, L. Muzii, P. Benedetti Panici, G. Scambia, F. Raspagliesi

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate the outcomes of high-risk (HR) HPV-positive and -negative women affected by high-grade cervical dysplasia. Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had at least 5 years of follow-up. A propensity-score matching was adopted in order to reduce the presence of confounding factors between groups. Kaplan-Meir and Cox hazard models were used to estimate 5-year outcomes. Results: Overall, data of 2966 women, affected by high-grade cervical dysplasia were reviewed. The study population included 1478 (85%) and 260 (15%) women affected by HR-HPV-positive and HR-HPV-negative high-grade cervical dysplasia. The prevalence of CIN2 and CIN3 among the HR-HPV-positive and -negative cohort was similar (p = 0.315). Patients with HR-HPV-positive high-grade cervical dysplasia were at higher risk of 5-year recurrence (after primary conization) that HR-HPV-negative patients (p < 0.001, log-rank test). Via multivariate analysis, HR-HPV-negative women were at low risk of recurrence (HR: 1.69 (95%CI: 1.05, 4.80); p = 0.018, Cox Hazard model). A propensity-score matched comparison was carried out in order to reduce biases that are related to the retrospective study design. In comparison to HR-HPV-negative patients, thosewith HR-HPV-positive CIN3 was associate with a 8-fold increase in the risk of recurrence (p < 0.001, log-rank test). Conclusions: HR-HPV-negative high-grade cervical dysplasia is not uncommon, accounting for 15% of our study population. Those patients experience more favorable outcomes than patients with documented HR-HPV infection(s). Further prospective studies are needed to corroborate our data.

Original languageEnglish
Pages (from-to)173-178
Number of pages6
JournalGynecologic Oncology
Issue number1
Publication statusPublished - 2021


  • CIN
  • Conization
  • HPV
  • Negative
  • Positive
  • adult
  • Article
  • cohort analysis
  • controlled study
  • female
  • follow up
  • high risk population
  • human
  • Italy
  • Kaplan Meier method
  • laser surgery
  • loop electrosurgical excision
  • major clinical study
  • medical record review
  • outcome assessment
  • papillomavirus infection
  • prevalence
  • priority journal
  • propensity score
  • proportional hazards model
  • recurrence free survival
  • recurrence risk
  • retrospective study
  • squamous cell lesion
  • uterine cervix carcinoma in situ
  • uterine cervix conization
  • uterine cervix dysplasia
  • vaccination


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