Study On The Related Factors Of High-risk Human Papillomavirus Outcom And Cervical Lession Recurrence And Residual After Conization

Background and ObjectiveOne of the most common gynecological tumors in the world is cervical cancer.It has been recognized that persistent high-risk human papillomavirus infection is a necessary condition for the development of cervical squamous intraepithelial lesions and cervical invasive carcinoma.Cervical squamous intraepithelial lesions reflect the continuous process in the occurrence and development of cervical cancer.Most low-grade squamous intraepithelial lesions(LSIL)can resolve spontaneously,but high-grade squamous intraepithelial lesions(HSIL)have the potential to become cancerous.This stage affected by various factors,the progress is slow and the patient has no symptoms.With the promotion and popularization of cervical cancer screening,more and more cervical cancer and precancerous lesions can be detected and treated early.According to the recommendations of the American Society of Colposcopy and Cervical Pathology(ASCCP)guidelines,patients with LSIL can be continuously observed and followed up according to their conditions,and HSIL patients,surgery can be slected.The current surgical treatment methods mainly include loop electrosurgical excision procedure(LEEP)and cold knife cervical conization(CKC).However,its effectiveness in completely eliminating HR-HPV infection is still controversial.Moreover,postoperative cervical precancerous lesions recurred or even progressed to more serious lesions still exist.Therefore,find clear risk factors that affect persistent HR-HPV infection and recurrence of lesions after conization,and improve the understanding of these factors,identify high-risk patients,take individualized follow-up mathers for such patients and timely intervention to prevent HR-HPV persistent infection or recurrence of lesions after surgery and further development of the disease is the research purpose.Materials and Methods1.Source of Materials:Selected 468 patients with cervical squamous intraepithelial lesions who were treated in our hospital from January 2014 to January2017 as the research objects.According to the different surgical methods,182 patients underwent LEEP in gynecological outpatient and 286 patients underwent CKC in gynecological ward were collected.All the collected subjects underwent TCT,HR-HPV quantitative and typing test before operation.Cervical biopsy under electronic colposcopy was performed,and the biopsy pathology was used as the pathological grading before conization,and pathological examination of the excised tissue was performed after the operation,and were followed up for more than 2years.Collect individualized indicators(age,pregnancy and parity,menopause)and laboratory indicators(preoperative HR-HPV load and type,pathological grade,whether glands are involved,the number of lesions involved,and whether the resection margin is positive,Conization specimen thickness,HPV infection status 6months after surgery)of all patients through the outpatient,ward,pathological case inquiry system and telephone follow-up.2.Statistical methods:Pearsonχ2 test,Bonferroni adjusted chi-square test,Fisher exact probability method and logistic regression analysis were used to univariate and multivariate retrospective analyze with statistical software SPSS23.0.The test level P<0.05 indicates that the difference is statistically significant.(x±s)means measurement data,n(%)means count data.Results1.Through rigorou spostoperative follow-up,55(11.75%)were persistent postoperative HR-HPV infection in 468 cases.And the HR-HPV load of patients infected with type 16 was significantly higher than that of other types.In the single HR-HPV infection group,16 types of infected patients ranked first in the postoperative HR-HPV persistent infection rate,which was significantly higher than that of other types of infections,and the difference was statistically significant(P<0.05).Univariate analysis found that preoperative high-risk human papillomavirus load≥500RLU/CO,multiple HR-HPV infection,HR-HPV type,preoperative high-grade squamous intraepithelial lesion,age≥45 years,menopause,number of lesions≥3 and Conization specimen thickness≤1cm was associated with persistent postoperative HR-HPV infection(χ~2:8.898、5.743、6.614、8.965、4.612、4.862、11.424、4.225),the difference was statistically significant(P<0.05).The number of pregnancy and parity,glands involved,and surgical methods were not related to persistent postoperative HR-HPV infection.Multivariate logistic regression analysis showed that conization specimen thickness≤1cm,number of lesions≥3,and preoperative HR-HPV load≥500 RLU/CO were independent risk factors for postoperative HR-HPV persistent infection(OR:2.275、5.244、8.112),the difference was statistically significant(P<0.05).2.468 patients were followed up after surgery,8.3%(39 cases)of patients had different levels of recurrence after surgery.Among them,16 patients had persistent postoperative HR-HPV infection,and the recurrence and residual rate of them was significantly higher than other patients.Univariate analysis found that age≥45 years old,menopause,persistent HR-HPV infection,HR-HPV multiple infection,HR-HPV load≥500RLU/CO,number of lesions≥3,preoperative pathological grade,positive resection margin,conization Specimen thickness≤1cm and lesions involved glands are related to the recurrence and residual of cervical lesions after conization(χ~2:6.471、8.904、35.155、4.973、no、6.451、13.960、11.578、4.393、4.801),the difference is statistically significant(P<0.05).Multivariate analysis found that postoperative HR-HPV persistent infection,resection margin positive,preoperative HPV load≥500RLU/CO,multiple infections and lesions involved glands were independent risk factors for postoperative cervical recurrence(OR:11.803、6.488、10.214、9.789、6.244),the difference was statistically significant(P<0.05).Conclusions1.Age≥45 years old,menopause,number of lesions≥3,thickness of pyramidal specimens≤1cm,multiple preoperative HR-HPV infection and HR-HPV load(≥500RLU/CO)are related to persistent postoperative HR-HPV infection.2.High preoperative HPV load(≥500RLU/CO),number of lesions(≥3)and conization specimen thickness(≤1cm)are independent risk factors for postoperative high-risk persistent human papillomavirus infection.3.Age≥45 years,menopause,persistent HR-HPV infection,multiple HR-HPV infection,HR-HPV load≥500RLU/CO,number of lesions≥3,pathological grade,positive margin,conization specimen Thickness≤1cm,lesions involving glands are associated with recurrence and residual cervical lesions after conization4.Persistent postoperative HR-HPV infection,positive postoperative margin,high preoperative HPV load(≥500RL U/CO),multiple infections and glandular involvement are independent risk factors for the recurrence and residual of cervical lesions after surgery.