Analysis Of Risk Factors For Postoperative Recurrence Of High-grade Intraepithelial Neoplasia Of The Cervix

Objective:High level cervical intraepithelial neoplasia(Highow-grade squamous intraepithelial lesion,HSIL)the risk factors of postoperative recurrence,for high risk groups to provide theoretical basis for the establishment of the standardization of the follow-up strategies.Methods:From January 2015 to March 2017,the clinical data of 101 patients with high-grade cervical intraepithelial neoplasia(HSIL)confirmed by pathology in our hospital,who underwent cervical coning and whose postoperative pathological report was still HSIL and whose incision margin was negative were analyzed retrospectively.SPSS20.0 software was used for statistical analysis.All patients were followed up 3,6 and 12 months after surgery.HPV typing and TCT(Thinprep Cytologic test)were used as follow-up monitoring indicators,and colposcopinoscopy was evaluated if any of them was positive.The presence of CIN lesions within 6 months after surgery is considered as residual,and recurrence is considered after 6 months.Cervical cancer screening should be performed once a year in normal patients with double negative HPV typing and TCT results.All the enrolled patients’ clinical data records are accurate and complete,and relevant examinations are complete.Results:13 cases in 101 cases of patients with recurrence,including 11 patients with HSIL(6cases of CIN Ⅲ level,5 cases of CIN Ⅱ level),2 patients with LSIL,recurrence rate was12.87%.Logistic regression analysis of clinical data showed that the risk factors for postoperative recurrence in HSIL patients were preoperative TCT indication of HSIL,menopause,postoperative HPV infection,and postoperative special subtypes 16 and 58 infection.Preoperative TCT indicated that HSIL accounted for 42.57%(43/101)and the recurrence rate was 84.62%(11/13).Preoperative TCT indicated that LSIL accounted for57.43%(58/101)and the recurrence rate was 15.38%(2/13).Postmenopausal patients accounted for 26.73%(27/101),and the recurrence rate was 69.23%(9/13).The premenopausal patients accounted for 73.27%(74/101),and the recurrence rate was30.77%(4/13).Postoperative follow-up results showed that the HPV positive rate andnegative rate were 76.92%(10/13)and 23.07%(3/13)in the patients with recurrence,and5.68%(5/88)and 94.32%(83/88)in the patients without recurrence.Age(P=0.278),preoperative HPV infection(P=0.961),preoperative single or multiple HPV infection(P=0.832),and postoperative single or multiple HPV infection(P>There was no significant correlation between the involvement of glands(P=0.397)and recurrence of high-grade cervical intraepithelial neoplasia.Preoperative infection rate of HPV58(13.86%,14/101)was higher,second only to that of type 16(61.39%,62/101).Among patients with postoperative recurrence,the positive rate of HPV16 was 69.23%(9/13),the negative rate was 30.77%(4/88),and the positive rate of HPV16 was 4.55%(4/88),and the negative rate was 95.45%(84/88).The differences were statistically significant(P<0.0001);The infection rate of HPV58 was 23.08%(3/13),while that of patients without recurrence was2.27%(2/88).The difference was statistically significant(P=0.011<0.05).Conclusion:1.Preoperative TCT suggested that HSIL,menopause,postoperative HPV infection,postoperative special subtypes 16 and 58 infection were the high risk factors for postoperative recurrence in patients with high-grade cervical intraepithelial neoplasia,and postoperative follow-up and management should be strengthened.2.Age,preoperative HPV infection,preoperative and postoperative single or multiple HPV infection,and whether the glands are involved or not have no significant correlation with the recurrence of high-grade cervical intraepithelial neoplasia.3.In clinical work,high attention should also be paid to patients with HPV58 infection.Postoperative follow-up and management can be similar to that of HPV16 infection.6months after the operation,routine colposcopy evaluation can be conducted,and cervical biopsy under colposcopy is feasible if necessary.4.If menopausal patients are not satisfied with the colposcopy evaluation,hysteroscopy may be considered to be used at the same time to evaluate whether the cervical canal is involved in lesions,so as to reduce missed diagnosis and postoperative recurrence.