Predictive Factors Analysis Of The Upgraded Pathological Results In Patients Of High Grade Cervical Lesions After Cervical Conization Surgery

Background and Objective:There is a long stage of precancerous lesions before the cervical lesions turn to be cervical invasive cancer,studies have shown that 15%-30% of patients with CIN2-3 will develop further into cervical cancer.In recent years,with the extensive promotion of cervical screening,more and more precancerous lesions,including high grade cervical lesions women were founded in time.The current surgical treatment of high grade cervical lesions is the main means,including cervical conization or hysterectomy(older,no fertility requirements of patients),however,there are many following questions of the hysterectomy of the patients with high grade cervical lesions,if we resect of the uterus direcrly,about 7% of the patients eventually diagnosed with invasive cancer,which leads to the scope of surgery is inadequate,Therefore,before hysterectomy of the patients with high grade cervical lesions,we often need to conization for diagnostic,waiting for the routine pathological examination result,if the result upgraded,then we make the hysterectomy surgery.In the process,the patients and their families are anxious,and the risk of infection increased,all these may brought to the patients and their families a greater economic burden and mental stress,after experienced second anesthesia,and long hospital staying.some experts suggested that diagnostic conization during intraoperative,and make rapid pathologic examination,according to the rapid pathologic examination results choose to immediately hysterectomy or expand the scope of surgery,although this can avoid the above drawbacks,but the rapid pathologic examination results may not accurate,the scope of surgery is not appropriate.Therefore,doctors need to judge whether the patient's pathology will be upgraded after surgery by the patient's own clinical features and auxiliary examinations before surgery,and choose a reasonable surgical approach for the patient with high grade cervical lesions.The main purpose of this study is to establish a risk model of postoperative upgrading pathological result for the patients with high grade cervical lesions.Methods:A total of 2,200 medical records of the patients were collected,all the patients' cervical biopsy was high grade cervical lesions and were treated in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2015,after sort out clinical data,the total number of the medical records that includs the following 13 fctors is 1032.the 13 factors are history of vaginitis,high-risk HPV infection history,Cervical transformation area,oral contraceptives,contact bleeding,marriage age,primiparous age,pregnant times,MRI results,sick recidivism points,age,smoking history,non-HPV infection of sexually transmitted diseases(STD).All the 1032 patients were divided into two groups accodring to the pathological results after cervical conization,the upgrading group and the no upgrading group,single factor analysis of each factor,define P <0.05 for the difference was statistically significant,Multivariate binary logistic regression analysis was performed on each factor with statistically significant differences.All data were analyzed by SPSS 20.0 software.Results:The analysis of these 13 factors showed that the chi-square value of the vaginitis? high-risk HPV infection,oral contraceptives,cervical transformation area,contact bleeding,marriage age,primiparous age,pregnant times,MRI results,sick recidivism points,age,smoking history,non-HPV infection of sexually transmitted diseases(STD)are 0.954,<0.001,7.176,86.219,0.073,0.580,0.815,0.380,713.65,8,28.984,94.630,6.713,9.299 respectively;p values are 0.329,0.985,0.070,<0.001,0.786,0.809,0.367,0.538,<0.001,<0.001,<0.001,0.010,0.002 respectively.there were differences in the results of the following six factors,such as Cervical transformation area,MRI results,sick recidivism points,age,smoking history,non-HPV infection of sexually transmitted diseases(STD),P<0.05.Binary logistic regression analysis of these six factors revealed that these six factors were independent risk factors for predicting postoperative pathological upgrading.Conclusion:Cervical transformation area,MRI results,sick recidivism points,age,smoking history,non-HPV infection of sexually transmitted diseases(STD)are independent risk factors for predicting the upgrding of pathological results in patients with high grade cervical lesions.Auxiliary examination and medical records are important before surgery,collecting these datas can improve the accuracy of the prediction of postoperative pathological results,,for the clinician to develop surgical programs have a certain reference value,which is important for the clinician to make an accurate choice for the surgery.