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- 저자 : Salvatore Lopez (검색결과 2 건)
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Gynecologic oncology at the time of COVID-19 outbreak
Giorgio Bogani,Claudia Brusadelli,Rocco Guerrisi,Salvatore Lopez,Mauro Signorelli,Antonino Ditto,Francesco Raspagliesi 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4
The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirusdisease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens tocurtail patient access to evidence-based treatment. Medicine is changing, basically due tothe limited available resources. In the field of gynecologic oncology, we have to re-designour treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is toachieve the maximum benefit from less demanding procedures. Extensive procedures shouldbe avoided, in order to reduce hospitalization and postoperative events that might increasethe in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopicprocedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assistedand isobaric procedures would be preferred over laparoscopy. A fair allocation of resources isparamount adequate treatments.
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Giorgio Bogani,Ciro Pinelli,Valentina Chiappa,Fabio Martinelli,Salvatore Lopez,Antonino Ditto,Francesco Raspagliesi 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: This study aimed to identify predictors of recurrence/persistence of cervicalintraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization. Methods: Retrospective analysis involving all consecutive women having conization for CIN2+between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models. Results: Data of 3,212 women were retrospectively identified. After a mean follow-up of 47(±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between priorconization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis,presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis,hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66–6.95) for HPV16/18 and HR=2.59(95% CI=1.21–5.55) for HPV types other than 16/18, positive margins at primary conization,HR=4.11 (95% CI=2.04–8.26) and HPV persistence after conization, HR=16.69 (95%CI=8.20–33.9), correlated with r-CIN2+, independently. Considering age-specific HPV typesdistribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population(>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test). Conclusion: HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18has a detrimental effect in young women, thus highlighting the need of implementingvaccination against HPV in this population. Further prospective studies are warranted fortailoring clinical decision-making for post-conization follow-up on the basis of risk factors.
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