| Objective:To analyze the clinical factors related to conizationi patients with advanced cervical intraepithelial neoplasia(HSIL),to predict the risk factors of positive incisal margin in patients with HSIL,and to provide thinking for individual treatment of patients with HSIL.Methods:Clinical data of patients with HSIL positive margin who underwent cervical conotomy [including cold knife conotomy(CKC)and Loop Eelectrosurgical Excision procedure(LEEP)] in Jiangxi provincial Maternal and Child Health Hospital from January 1,2018 to December 31,2020 were collected,and patients with HSIL negative margin during the same period were collected in a ratio of 1:3.There were162 patients with positive margins and 486 patients with negative margins.Due to incomplete clinical data of 3 patients in the positive group and 1 patient in the negative group,159 patients with positive margins and 485 patients with negative margins were finally included in the analysis.Clinical related factors such as patient age,menopausal status,surgical method,glandular involvement,and lesion severity were recorded in detail,and univariate and multivariate analysis was performed on the data to explore the risk factors of positive margin in patients undergoing conical excision of the cervix.Kruskal-Wallis rank sum test(K-W test)was used for numerical data in the univariate analysis,and Chi-square test was used for classified data.P<0.05 was considered statistically significant.All statistically significant correlation factors in the above analysis were analyzed by multivariate analysis,and binary regression analysis was used.P<0.05 was considered statistically significant.R language was used to construct the risk prediction model for the factors with statistical differences among the multiple factors.Results:1.1 Results of single factor show that: Age,surgical method(CKC,LEEP),results of cervical tubecurettage(ECC)(HSIL,negative +LSIL),glandular involvement or not,degree of lesion(CIN2,CIN3,CIS,AIS),number of lesions involved(1,2,3,4),The results of TCT(NILM,LSIL+ASC-US,HSIL+ASC-H+AGC)were correlated with the status of the incisal margin(P<0.05),the status of menopause,and the type of cervical transformation zone(I,II,III).Cervical thickness(≤ 2.5cm,2.6-3cm,>3cm),cone height and cone width were not correlated with the state of incisal margin(P> 0.05).1.2 Age groups were analyzed.In patients ≤35 years old,surgical methods and lesion quadrant involvement were related to the state of incisal margins(P<0.05).In 35-50 year old patients,menopausal status,ECC,TCT results,glandular involvement,and lesion involvement were correlated with the status of the incisal margin(P<0.05).In patients ≥50 years old,the pathological grade of ECC,whether glands were involved or not,and the number of lesion quadrants involved were related to the state of the incisal margin(P< 0.05).2.According to the analysis of the increase of positive sites on the incisal margin,whether the risk factors associated with different positive sites are the same,patients with positive incisal margin were divided into internal incisal margin and external incisal margin.Among them,135 patients had internal incisal margin and 30 patients had external incisal margin.Statistical analysis of the cone height of patients with internal incisional margin and the cone height of negative incisional margin showed that the cone length of positive specimens was 18.92 mm and that of negative specimens was 20.28 mm,with statistical difference(P=0.011).Statistical analysis of cone width of patients with external incisional margin and negative incisional margin showed that the cone width of specimens in the positive group was 28.83 mm and that in the negative group was 27.22 mm,with no statistical significance(P=0.121).3.1.Multiple Logistic regression equation was constructed including age,surgical method and ECC.The results found that: The older the age,the higher the positive rate of conical margin after conical resection,with statistical significance(OR=1.037,95%CI 1.01-1.066,P=0.008),the TCT grade increased the risk of positive margin after conical resection.It was statistically significant(OR=1.403,95%CI 1.001-1.966,P=0.049).Compared with cold-knife conical resection,LEEP increased the risk of positive margins,and the difference was statistically significant(OR=9.035,95%CI 4.479-18.227,P<0.001).More quadrants of lesion involvement increased the risk of positive incisal margins,and the difference was statistically significant(OR=2.499,95%CI 1.911-3.268 P<0.001).3.2 Multivariate analysis was performed according to age groups.The results showed that LEEP increased the risk of positive incisal margin in the age group ≤35 years old,and the difference was statistically significant(OR=3.057,95%CI1.255-7.444,P=0.014).In the 35-50 age group,the more quadrants involved,the higher the positive margin rate after conical resection(OR=1.863,95%CI1.376-2.523,P<0.001).In the ≥50 age group,the lesion involved glands would be an independent exposure factor for marginal status,with a statistically significant difference(OR=5.388,95%CI 1.457-19.920,P=0.012).4.R language was used to construct a risk prediction model based on four independent risk factors including age,TCT results,surgical methods and quadrants of lesion involvement,which confirmed that the model had high reliability(AUC=0.792).Conclusion:1.Independent risk factors for positive margin after cervical conectomy in patients with HSIL were age,surgical method,TCT grade,and number of quadrants involved.2.In clinical work,individual management should be implemented according to different patients,so as to preserve the fertility of patients and reduce the rate of uterine loss as much as possible while curing the disease... |
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