Analysis Of Risk Factors For Recurrence Of Cervical High Grade Squamous Intraepithelial Lesions In Patients With Negative Cone Margin

To assess the risk factors related to recurrence in patients with negative margin after cold knife conization(CKC)for high-grade squamous intraepithelial lesions(HSIL).Objective:The clinical data of patients who underwent CKC surgery in Department of Gynecology of Qilu Hospital of Shandong University due to cervical HSIL from January 1,2014 to December 31,2020 were collected.The postoperative follow-up of each patient was recorded in the form of telephone follow-up and outpatient follow-up.The patients who met the inclusion criteria with and without recurrence were included in the study.Files were collected containing information about the patient’s age,menopause status,gravidity,parity,preoperative cervical cytology results,preoperative high-risk human papilloma virus(HR-HPV)infection,cervical transformation area type,preoperative endocervical curettage(ECC)pathological results,cone height,postoperative cervical histopathological grade,glands involvement,cervical cytological results and HR-HPV infection 6 months after operation.Cervical cytology and HR-HPV were performed on each patient at 6 and 12 months after operation.From the second year after operation,the frequency of combined testing was changed to once every 6-12 months.The patients with abnormal cytological results and/or HR-HPV infection continued for 1 year were underwent colposcopy guided cervical biopsy and/or ECC if indicated.More than six months after cervical conization,any grade of cervical squamous intraepithelial lesions confirmed by histopathology again was called lesion recurrence.Binary logistic regression was used to analyze whether the above clinical factors were related to the recurrence of lesions in patients with negative margin after CKC for HSIL.Results:From January 1,2014 to December 31,20 20,2 3 3 6 patients were treated in Qilu Hospital of Shandong University with negative margin after CKC due to HSIL and met the inclusion criteria.Until December 31,2021,77 patients had disease recurrence,and the recurrence rate was 3.3%.36.36%(28/77)patients had disease recurrence within 12 months,29.87%(23/77)patients had disease recurrence within 12-18 months,and 9.09%(7/77)patients had disease recurrence within 18-24 months.75.32%(58/77)of recurrences recurred within 2 years after operation.Univariate logistic regression analysis showed that the patient’s age,menopause status,gravidity,parity,preoperative cervical cytology results,preoperative HR-HPV infection,cervical transformation area type,cone height,postoperative cervical histopathological grade,glands involvement were not related to the recurrence of HSIL after CKC(P>0.05).Preoperative ECC pathological results(OR=5.203,95%CI=2.558-10.583,P<0.001),cervical cytological results 6 months after operation(OR=10.703,95%CI=4.767-24.031,P<0.001)and HR-HPV infection 6 months after operation(OR=11.503,95%CI=6.343-20.862,P<0.001)were associated with the recurrence of HSIL after CKC.Multivariate logistic regression analysis showed that positive ECC pathology before operation,positive cervical cytology 6 months after operation and HR-HPV infection 6 months after operation were independent risk factors for recurrence of HSIL after CKC.Conclusion:The recurrence rate of HSIL with negative margin after CKC was 3.3%.Most recurrences occurred within two years after operation.Positive ECC pathology before operation,positive cervical cytology 6 months after operation and HR-HPV infection 6 months after operation were independent risk factors for disease recurrence.For patients with each of above risk factors,postoperative follow-up should be strengthened,especially within 2 years after operation.