| Background and ObjectivesCervical cancer is one of the most common malignancies of female reproductive system.In recent years,the incidence of cervical cancer is on the rise,and the age of onset is getting younger.Cervical high-grade squamous intraepithelial lesion(HSIL)is a kind of precancerous lesions,which has a higher risk of progressing to cervical cancer,and the cervical cold knife conization(CKC)is commonly used in the clinical treatment of HSIL pathological change operation,but because of its reproductive function for the preservation of the operative type,part of postoperative patients may have cut edge positive and residual lesion,and bring great trouble to the patients and family.Therefore,it is very important to actively explore the risk factors of positive margin and residual lesions in patients with HSIL after cold knife conization,so as to identify these risk factors early and treat them timely.Materils and Methods303 patients with high level cervical squamous intraepithelial lesions who received the cervical cold knife conical surgery treatment and were followed up for at least half a year at the Second Affiliated Hospital of Zhengzhou University from January 2015 to June 2020 was chosen,and were divided into groups according to the state of the surgical margin and the presence or absence of postoperative residual lesions,including 46 patients in the positive margin group,257 patients in the negative margin group,29 patients in the residual group,and 274 patients in the non-residual group.The clinical data were retrospectively analyzed and studied.the clinical data were retrospectively analyzed.Univariate analysis was performed for age,menopausal status,pregnancy and birth,preoperative Human papillomavirus(HPV)infection,Thinprep cytology test(TCT)results,lesion involvement of the gland,intraoperative coning height,and other data of the two groups,thus the risk factors of positive cervical margin and residual lesions after cervical conization were screened out,and then dichotomous Logistic regression analysis was conducted to determine the independent risk factors of positive cervical margin and residual lesions after cervical conization.Results1.The single factor analysis showed that there was a statistically significant difference between the margin positive group and margin negative groups in preoperative HPV infection classification(χ~2=5.153,P=0.023),the lesion tired state of gland(χ~2=10.202,P=0.001)and the height of the cone cutting groups(χ~2=10.700,P=0.001).There was no statistically difference in the comparison of age,pregnancy and birth,menopausal status,and the comparison of types of HPV infection in the preoperative(P>0.05);About the residual lesion group and no residual lesion group,there was a statistically significant difference in preoperative HPV infection classification(χ~2=8.531,P=0.003),the cut edge state(χ~2=24.509,P<0.001),postoperative follow-up TCT results(χ~2=46.610,P<0.001),and HPV outcome at 6months after operation(χ~2=44.905,P<0.001),but there was no statistically difference in the comparison of age,pregnancy and birth,menopausal status,preoperative types of HPV infection,gland lesions tired state and the height of the cone cutting groups(P>0.05).2.Multivariate two-class Logistic regression analysis showed that the independent risk of positive cervical margin after coning included preoperative HPV16/18 infection(OR=2.486,95%CI=1.176-5.255,P=0.017),the lesion involves the gland(OR=8.992,95%CI=2.079-38.888,P=0.003)and intraoperative coning height≤1.5cm(OR=3.179,95%CI=1.626-6.217,P=0.001).Whereas preoperative HPV16/18 infection(OR=3.699,95%CI=1.222-11.193,P=0.021),positive surgical margin(OR=6.183,95%CI=2.692-14.200,P<0.001),postoperative TCT follow-up results were ASCUS and above(OR=5.649,95%CI=1.306-24.438,P=0.020),and HPV did not turn negative for half a year after surgery(OR=15.565,95%CI=3.424-70.760,P<0.001)was an independent risk factor for residual lesions after cervical conization.3.In the 46 patients with positive margin group,there was a statistically significant difference in the residual rate of lesions between the patients with positive internal margin and those with negative margin(χ~2=31.186,P<0.001)),while there was no statistically significant difference in the residual rate of lesions between the patients with positive external margin and those with negative margin(χ~2=2.251,P=0.134).According to the number of positive surgical margin points,there was a statistically significant difference in the residual rate between the number of positive surgical margin points(>3 points)and the number of positive surgical margin points≤3 points(χ~2=6.715,P=0.01).Conclusions1.Preoperative HPV16/18 infection,the lesion involves the gland and intraoperative coning height≤1.5cm were independent risk factors for positive cervical coning margin after coning;2.Preoperative HPV16/18 infection,positive surgical margin,postoperative TCT follow-up results were ASCUS and above and HPV did not turn negative for half a year after surgery were independent risk factors for residual lesions after cervical conization;3.Positive internal margin and positive multi-point margin(>3 points)were associated with residual lesions after cervical conization. |
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