Table 1_Risk factors for HR-HPV persistence and residual or recurrent high-grade squamous intraepithelial neoplasia after LEEP.docx

GEE analysis showed significant differences in type-specific persistence among the α5/6, α7, and α9 species (P = 0.024), with higher persistence in α5/6 than α7 (27.1% vs. 14.0%; OR = 2.30, 95% CI, 1.09–4.85; adjusted P = 0.024), but no significant differences between α5/6 and α9 or between α7 and α9. Multiple HR-HPV infections (OR = 2.76, 95% CI, 1.96–3.89; P < 0.001) and menopausal status (OR = 2.06, 95% CI, 1.18–3.66; P = 0.011), and positive endocervical margins (OR = 2.54, 95% CI, 1.48–4.32; P = 0.007) were associated with HR-HPV persistence.

During follow-up, 32 patients (3.5%) developed residual or recurrent HSIL (21 residual, 11 recurrent). Firth's penalized regression identified persistent type-specific HR-HPV infection (OR = 21.88, 95% CI, 8.25–72.76; P < 0.001), number of involved cervical quadrants (P = 0.025), endocervical involvement (P = 0.006), and surgical margin status (P < 0.001) as independently associated with residual or recurrent HSIL.</p>Conclusions<p>α5/6 species showed a higher type-specific HR-HPV persistence than α7 but not α9 following LEEP.

Multiple HR-HPV infections, menopausal status, and positive endocervical margins were associated with HR-HPV persistence. Persistent type-specific HR-HPV infection, multiple involved cervical quadrants, endocervical involvement, and positive surgical margins were independent predictors of residual or recurrent HSIL. Multicenter studies are warranted to validate integrating margin status with HPV genotyping for postoperative risk stratification.</p>