Clearance of Human Papillomavirus (HPV) and Associated Factors in Patients With Cervical HPV-Associated Lesions After Conization

Background: The factors associated with high-risk human papillomavirus (HR-HPV) clearance and its regulation following conization of cervical HPV-associated lesions remain unclear. Methods: Information was extracted on patients who underwent cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) at the Affiliated Hospital of Qingdao University and Zhucheng People’s Hospital between September 2014 and September 2020. We compared postoperative HR-HPV clearance between the CKC and LEEP groups using Kaplan-Meier (K-M) curves and calculated the restricted mean survival time (RMST) for each group. Subsequently, we employed univariate and multivariate logistic regression analyses to determine independent prognostic factors. Results: In total, 339 patients were enrolled, including 182 patients who underwent CKC (53.7%) and 157 patients who underwent LEEP (46.3%). The HPV16/18 regression rates were 92.2% and 85.7% in the CKC and LEEP groups, respectively. Patients who underwent LEEP experienced a longer HR-HPV regression period than those who underwent CKC, along with significantly lower regression rates [hazard ratio (HR): 0.795; 95% confidence interval (CI): 0.223–0.974; p = 0.049]. The RMST of HR-HPV positivity after surgery was 5.23 months in the CKC group and 5.79 months in the LEEP group (p = 0.463). Multivariable analysis identified LEEP as an independent risk factor for persistent positive HR-HPV after surgery (odds ratio (OR): 5.730; 95% CI: 1.236–26.568; p = 0.026). Conclusions: CKC is associated with faster, more complete clearance of HR-HPV compared with LEEP. Procedure selection should prioritize adequate excision while preserving healthy tissue. Nonetheless, prospective, standardized studies are needed to confirm these findings.