The Risk Factors Of Residual Lesions And Recurrence Of The High-grade Cervical Intraepithelial Lesions (HSIL) Patients With Positive-margin After Conization

Background:The incidence of cervical cancer,one of the most common gynecological tumors,has been continuously increasing in recent decades.Cervical intraepithelial neoplasia(CIN)is a precursor of cervical cancer.Accurate and standardized treatment of cervical lesions,especially high-grade cervical intraepithelial lesions(HSIL),is considered as the most important method to prevent cervical cancer.Conization currently is one of the main treatments of cervical precancerous lesions,which plays both diagnostic and therapeutic roles in CIN.Cold knife conization(CKC)and loop electrosurgical excisional procedure(LEEP)are the most common strategies.However,there are still around 15%of patients relapse or have residuals after surgery.Recurrence and progression are the most worried problems caused by residual lesion.Evidence indicates that margin involvement,histopathological CIN grade,glandular involvement,persistent human papillomavirus(HPV)infection,age,and immunosuppression are predictive factors associated with CIN residual and recurrence rate.Positive margin is always regarded as a high risk factor for residual lesion and recurrence.However,few analysis focusing on the positive margin patients has been published up to date.Objective:The aim of this study was to illuminate risk factors of residual lesions,and recurrence of the high-grade cervical intraepithelial lesions(HSIL)patients with positive margin who underwent cervical conization.Methods:A retrospective cohort study of 218 patients with positive margin after conization,including cold knife conization(CKC)and loop electrosurgical excisional procedure(LEEP),and follow-up from 2013 through 2016.The diagnosis of residual disease and recurrence were established and confirmed by biopsy.We evaluated the correlations among residual rate,recurrence rate and clinical parameters,such as age,menopausal status,gravity,parity,glandular involvement,thinprep cytologic test(TCT)and Human papilloma virus(HPV)results.We also detected the difference between CKC and LEEP.Result:There was statistical difference between the positive margin rate of CKC group and LEEP regarding the surgery methods(5.8%and 12.09%separately,p<0.001).Residual disease were found in 53.66%cases where 41 patients received second surgery after conization.Besides,age(p=0.027),menopausal status(p=0.006)and HPV infection(p=0.018)were significantly associated with residual lesion.Among 177 cases with histopathologic follow-up,14.68%women replased from 4 to 27 months.As for recurrence we found it was more frequent with HPV infection and glandular involvement(p<0.001).TCT result was also an independent factor in patients with recurrence of lesion(p=0.031).No evidence showed difference between CKC and LEEP for recurrence rate(p=0.918).Conclusions:The factors related to rate of residual lesion were age,menopausal status and HPV infection.HPV infection,TCT and glandular involvement were associated with HSIL recurrence.Although the LEEP group had a higher positive margin rate,it was as effective as CKC with regard to recurrence rate.Further large-scale studies are needed to confirm our findings.