{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:11:06Z","timestamp":1780319466130,"version":"3.54.1"},"reference-count":183,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Immunosuppressed women are at increased risk of residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2\u20133) after excisional treatment, yet long-term comparative data remain limited. Previous studies are often small and heterogeneous, and they rarely compare outcomes directly with immunocompetent populations. This study evaluated the long-term incidence, timing and associated factors of CIN 2\u20133 recurrence after large loop excision of the transformation zone (LLETZ), stratified by immune status. Methods: We conducted a retrospective cohort study including 283 women treated with LLETZ for CIN 2\u20133 between 1996 and 2016 at Bellvitge University Hospital in Barcelona, Spain. Of these, 41 were immunosuppressed and 242 immunocompetent. Clinical, histopathological, virological, and immunological variables were extracted from hospital and pathology registries. Kaplan\u2013Meier estimates and Cox proportional hazards models adjusted for immunosuppression status were used to evaluate time-to-recurrence and factors associated with recurrence. Results: At 36 months post-treatment, the probability of residual\/recurrent CIN 2\u20133 was 44% in immunosuppressed women versus 5% in immunocompetent women (HR = 10.42, 95% CI 4.70\u201323.08, p &lt; 0.001). Recurrence appeared earlier in immunosuppressed women (median 7 vs. 13 months). Persistent high-risk HPV infection at first follow-up (HR = 23.6, 95% CI 5.44\u2013102, p &lt; 0.001) and positive surgical margins (HR = 3.88, 95% CI 1.45\u201310.3, p = 0.007) were among the factors most strongly associated with recurrence, and advanced immunodeficiency (CD4+ &lt; 200 cells\/mm3 or detectable HIV viral load) was associated with earlier recurrences, though this association was not maintained after accounting for immunosuppression status in Cox models. Conclusions: Immunosuppressed women are at significantly higher and earlier risk of residual\/recurrent CIN 2\u20133 after LLETZ. These findings support a risk-adapted, multidisciplinary follow-up integrating gynecologic, infectious disease, and immunologic care. Tailored surveillance and perioperative HPV vaccination may enhance secondary prevention in this high-risk population.<\/jats:p>","DOI":"10.3390\/cancers18111695","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:06:08Z","timestamp":1779465968000},"page":"1695","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Risk of Residual or Recurrent CIN 2\u20133 After LLETZ in Immunosuppressed vs. Immunocompetent Women: A 20-Year Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5435-0805","authenticated-orcid":false,"given":"Christian Leonardo","family":"Molina-Hinojosa","sequence":"first","affiliation":[{"name":"Doctoral Program in Pediatrics, Obstetrics and Gynecology, Doctoral School, Universitat Aut\u00f2noma de Barcelona, 08193 Bellaterra, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Carreras-Collado","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital del Mar, Universitat Aut\u00f2noma de Barcelona, 08193 Bellaterra, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0047-1991","authenticated-orcid":false,"given":"Mar\u00eda","family":"Saumoy-Linares","sequence":"additional","affiliation":[{"name":"HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Pe\u00f1afiel","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Heydari","sequence":"additional","affiliation":[{"name":"Medicine and Translational Research Doctorate Program, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3366-2241","authenticated-orcid":false,"given":"Joan Climent","family":"Mart\u00ed","sequence":"additional","affiliation":[{"name":"Department of Immunology, Germans Trias i Pujol Research Institute (IGTP), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Eulalia","family":"Fern\u00e1ndez-Montol\u00ed","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Bellvitge University Hospital, Biomedical Research Institute (IDIBELL), Universitat de Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global Estimates of Incidence and Mortality of Cervical Cancer in 2020: A Baseline Analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"Singh","year":"2023","journal-title":"Lancet Glob. 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