Evaluation of Risk Factors Associated with Expectant Management in CIN 1/2: A Multicenter Real-World Cohort Study.

Area of Science:

• Gynecology
• Oncology
• Infectious Diseases

Background:

• Cervical intraepithelial neoplasia (CIN) grades 1 and 2 are common precancerous cervical conditions.
• Evaluating expectant management versus immediate surgery is crucial for optimizing patient care.
• Understanding factors influencing CIN regression and progression is key for risk stratification.

Purpose of the Study:

• To assess the effectiveness of expectant management for CIN 1 and CIN 2.
• To identify factors associated with regression and progression of CIN 1 and CIN 2.
• To compare outcomes between expectant management and immediate surgical intervention.

Main Methods:

• Multicenter study involving 561 women managed expectantly and 359 undergoing immediate surgery.
• Data collected between 2013 and 2023.
• Analysis of regression, progression, and factors influencing outcomes, including human papillomavirus (HPV) types and cytology results.

Main Results:

• Over 4 years, 63% of CIN 1 and 68% of CIN 2 cases regressed; 9% of CIN 1 and 14% of CIN 2 progressed.
• Median regression times were 1.5 years for CIN 1 and 1.2 years for CIN 2.
• High-risk HPV types (e.g., HPV 58), high-grade initial cytology (ASC-H, HSIL), and hematological disorders were linked to lower regression likelihood.

Conclusions:

• CIN 1 and CIN 2 commonly regress, supporting expectant management for up to 1.5 years.
• HPV 58 infection, high-grade initial cytology, and hematological disorders necessitate careful monitoring.
• Patients in their 30s or with HPV 16 infection face increased risk of pathologic upgrading during surgery.