Oktar O, et al. J Gynecol Oncol. 2023 Dec;35:e39. https://doi.org/10.3802/jgo.2024.35.e39

Persistent high-risk human papillomavirus (HPV) infection is the primary etiological factor in cervical cancer, with HPV16 and HPV18 posing the greatest oncogenic risk. Although systemic inflammation and nutritional indices such as the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and Prognostic Nutritional Index (PNI) have prognostic value in various malignancies, their role in predicting HPV persistence remains unclear. This study aimed to evaluate the predictive value of HALP and PNI scores for one-year HPV persistence and additionally assessed other inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). This retrospective study included 470 HPV-positive women aged 31-67 years who were followed for at least one year between January 2021 and March 2025. Participants were categorized into Group N (HPV clearance, n = 271) and Group P (HPV persistence, n = 199) according to one-year HPV results. Baseline demographic, clinical, histopathological, and laboratory data were collected. HALP and PNI scores were calculated from hemoglobin, albumin, lymphocyte, and platelet counts, and inflammatory markers including NLR, PLR, and CRP were evaluated. Group comparisons were performed using appropriate statistical tests, and predictive performance was assessed using receiver operating characteristic (ROC) analysis. Continuous variables were standardized using Z-score transformation before multivariate logistic regression to minimize scale differences among predictors. Within a year, 271 (57.7%) of the 470 women achieved viral clearance, whereas 199 (42.3%) had persistent infection. No substantial differences were observed in demographic or histological parameters. Vaccination after diagnosis did not affect clearance rates. The median HALP and PNI scores were similar between groups and provided no discriminatory ability [HALP AUC = 0.475 (95% CI: 0.422-0.528); PNI AUC = 0.487 (95% CI: 0.434-0.540)], as did PLR [AUC = 0.513 (95% CI: 0.460-0.566)] and CRP [AUC = 0.462 (95% CI: 0.409-0.515)]. In contrast, NLR was significantly higher in the persistence group (p < 0.001) and demonstrated modest discriminatory ability [AUC = 0.623 (95% CI: 0.573-0.673)]. HPV16 and HPV18 positivity was strongly associated with persistence. When the researchers evaluated the subjects' systemic inflammatory and nutritional status, they found that HALP, PNI, PLR, and CRP did not provide effective predictive value for one-year HPV persistence. Conversely, NLR exhibited a promising capacity to function as a straightforward systemic inflammatory marker. The presence of HPV16 and HPV18 was found to be significantly associated with the persistence of the infection, thereby corroborating the established immune evasion mechanisms associated with these types. These findings underscore the necessity for prognostic markers that integrate both local mucosal immune responses and systemic inflammatory pathways to enhance risk stratification and management of HPV-related disease.

Objectives: Persistent Human Papillomavirus (HPV) infection in the cervix and the preinvasive lesions it causes are significant risk factors for cervical cancer. Therefore, a treatment strategy is necessary to facilitate the clearance of HPV and prevent the progression of preinvasive lesions without causing cervical tissue destruction. This study aimed to evaluate the effectiveness of a vaginal adsorbent gel composed of a hydroxyethyl cellulose matrix formulation containing dispersed silicon dioxide, antioxidant sodium selenite, deflamin, and citric acid in patients with HPV infection. Methods: The study was designed as a retrospective cohort study and involved 449 women infected with HPV. For the purposes of the study, the patients were divided into two groups: the treatment group (TG) comprised 207 patients who used the vaginal gel daily for a period of three months, while the control group (CG), consisting of 242 patients, received no treatment under an “active surveillance” protocol. The study’s endpoints encompassed the domains of cytology, histology, and HPV clearance. Results: The regression rate of smear pathologies was 24.8% in the control group and 29.0% in the group using the vaginal adsorbent gel. In the first year, the histological regression rate in cervical biopsies was 49.3% in the treatment group and 19.4% in the control group, with a significant difference between groups (p < 0.001). Moreover, the clearance rate of HPV types was found to be significantly higher in the group using the vaginal adsorbent gel. Conclusions: The findings of this study suggest that the outpatient treatment approach can effectively prevent the oncogenic progression of cervical dysplasia. This alternative method has been shown to be efficacious in preventing the progression of cervical dysplasia and promoting regression. Furthermore, the efficacy of this gel in eradicating HPV has been demonstrated within a 12-month period.

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for cervical tissue regeneration. Methods: This prospective observational study included 28 patients who underwent MESC due to abnormal cervical cytology or biopsy-confirmed cervical intraepithelial neoplasia. Preoperative, postoperative one month and six month cervical measurements were obtained using two-dimensional transvaginal ultrasonography. Monthly colposcopic evaluations were conducted, cervical biopsies were taken at the third month, and a cytological assessment was performed at the sixth month. Cervical volume and length regeneration were calculated and analyzed in relation to the dimensions of the excised cone. Regeneration percentages and their correlations with excised tissue dimensions were evaluated using paired t-tests and Pearson correlation analysis. Results: Mean cervical volume and length regeneration rates at six months were 84.61% ± 5.64 and 86.36% ± 3.33, respectively. The transformation zone was histologically visible in 32.1% of patients at three months and cytologically in 75.9% at six months. An inverse correlation was observed between both cone volume and length and cervical regeneration (p < 0.005). Patients with larger preoperative cervical dimensions exhibited a higher regenerative capacity. Positive surgical margins were found in only one patient (3.4%), and no high-grade cytologic abnormalities were noted at follow-up. Conclusions: MESC may enable substantial cervical regeneration within six months. Larger excisions impair healing and delay transformation zone reformation, which may inform the optimal timing for initiating gynecological and colposcopic examinations, as well as for performing cervical interventions when indicated.

Background: The optimal extent of cervical excision according to transformation zone anatomy remains uncertain. This study evaluated the association of transformation zone (TZ) type with surgical margin status, margin localization, and conization specimen dimensions and explored TZ-specific cone length estimates associated with negative surgical margins. Methods: This retrospective cohort study included 323 women who underwent cervical conization for high-grade squamous intraepithelial lesions (HSIL; cervical intraepithelial neoplasia grades 2 and 3 [CIN2–3]) between January 2022 and November 2025. TZ types were classified as TZ1, TZ2, or TZ3. Cone dimensions and surgical margin outcomes were compared across TZ types. Multivariable logistic regression was performed to evaluate factors associated with positive surgical margins, and receiver operating characteristic (ROC) analysis was used to explore overall and TZ-specific cone length estimates associated with negative surgical margins. Results: Overall positive surgical margin rates did not differ significantly across TZ types (TZ1, 18.2%; TZ2, 12.0%; TZ3, 19.0%; p = 0.319). In the multivariable model excluding surgical excision dimensions, TZ type was not significantly associated with margin positivity. In a separate conditional-on-length model, TZ2 (OR 3.94, 95% CI 1.36–11.43) and TZ3 (OR 6.92, 95% CI 2.40–20.00) were associated with higher odds of positive margins compared with TZ1, whereas greater cone length was associated with lower odds of margin positivity (OR 0.037, 95% CI 0.014–0.099). Conclusions: TZ type was associated with distinct patterns of surgical margin localization following cervical conization. Although overall margin positivity did not differ significantly across TZ types, the conditional-on-length analysis indicated that the relationship between TZ anatomy, excision length, and margin status is interdependent. These findings highlight the relevance of TZ anatomy when interpreting surgical margin patterns, while the proposed TZ-specific cone length estimates remain exploratory and require prospective external validation before clinical application.