Risk factors analysis of persistence, progression and recurr
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Although vaginal intraepithelial neoplasia (VAIN) will regress in most patients, patients are still at risk of persistence, recurrence, and progression. Progression to vaginal cancer is rare, but the risk exists, especially for VAIN 3. HPV 16, 56, 59, and 43 infections predict the persistence of VAIN.

The objective was to profile patients with vaginal intraepithelial neoplasia (VAIN), to evaluate natural history, and to identify risk factors for persistence, progression, and recurrence.

All patients with histologically confirmed VAIN over a five-year period with a minimum follow-up of 6 months were retrospectively identified. Demographics, medical history, and clinical information related to the diagnosis and treatment were extracted. Clinical outcomes included normalization, persistence, progression, and recurrence. A total of 1478 patients fulfilled the inclusion criteria.

- In 86.6% of patients, VAIN went into normalization, 6.4% persisted, 3.5% progressed and 3.5% recurred. Besides, 24 VAIN 3 patients and 4 progressed to cancer, accounting for 85.7% and 14.3% of cancer cases, respectively.

- VAIN 3 patients treated with excision yielded superior outcomes.

- Risk factors for persistence were HPV 16, 56, 59, and 43 infections, for progression were prior hysterectomy for cervical lesions and HPV 56 infection, for recurrence were HPV 61 infection.

Patients with VAIN 3 are at higher risk of progressing to cancer and excision is preferred. HPV 16, 56, 59, and 43 infections might associate with an increased risk of persistence, and patients with prior hysterectomy for cervical lesions tend to progress.

Gynecologic Oncology
Source: https://doi.org/10.1016/j.ygyno.2021.06.027
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