The Proportion and Predicting Factors of Residual Disease after Conization of Women Diagnosed with Adenocarcinoma in Situ (AIS) in a Tertiary Center

Objectives: To investigate the proportion of residual disease after conization and the factors that significantly predict residual disease in patients diagnosed with adenocarcinoma in situ (AIS) on conization who underwent subsequent hysterectomy. Materials and Methods: Medical records of patients who were diagnosed with AIS on conization during 2007-2019 were retrospectively reviewed, and the data were followed until December 2020. Demographic/clinical data, method of conization, pathology results, follow-up data, and oncologic outcomes were analyzed using descriptive statistics. Logistic regression for univariate and multivariate analyses in a stepwise model was used to identify factors that predict residual disease in hysterectomy tissue. Results: A total of 149 AIS patients were evaluated for eligibility. Of those, 57 patients were excluded due to having coexisting adenocarcinoma. The remaining 92 patients were recruited. The mean age of patients was 43.4 ± 10.8 years. The most common preceding cytology was high-grade squamous intraepithelial lesion (HSIL). Subsequent hysterectomy was performed in 68 patients, and 20 (29.4%) of those were found to have residual disease. Age ≥ 50 and absence of coexisting HSIL were significant in univariate analysis, but only age ≥ 50 years [adjusted odds ratios (aOR): 3.667, 95% confidence interval (CI) 1.224-10.980, p = 0.017] was identified as an independent predictor of residual disease in multivariate analysis. The median follow-up time was 58.4 months, and all 92 patients were alive without disease. Conclusion: The proportion of residual disease in patients diagnosed AIS was 29.4%. Age ≥ 50 years was identified as the only independent predictor of residual disease.