| Objective(s):To explore the relationship between preoperative vaginal microecology and HPV infection and postoperative clinicopathological factors in cervical cancer,and to provide reference for the prevention,treatment and prognosis evaluation of cervical cancer.Methods:The preoperative vaginal microecology,HC2-HPV test results and postoperative clinical and pathological data were collected from 102 cervical cancer patients who underwent surgery in the Department of Gynecology,Yunnan Cancer Hospital from February to December 2017.Results:(1)102 cases of cervical cancer patients aged 27 to 66 years,mean(46.50±9.13 years),clinical stage:mainly ?B stage(accounting for 87.25%),followed by stage ?A(accounting for 10.78%);?A stage accounted for 1.96%.1 case of cervical cold knife conization,1 case of extensive hysterectomy,double attachment resection,extensive hysterectomy,double attachment resection and pelvic lymph node dissection in 92 cases,extensive hysterectomy,double fallopian tube resection and pelvic cavity Lymph node nodules and bilateral ovarian suspension in 8 cases.(2)Preoperative vaginal microecological status:Among 102 patients with cervical cancer,the incidence of vaginal microecological disorders was 91.18%(93/102).Among them:?The vaginal flora concentration,microbial diversity,and dominant bacteria anomalies accounted for 44.12%,66.67%,and 87.25%,respectively.?Pathogenic microorganisms:The detection rates of TV,VVC and BV were 0.98%,0.98%and 16.67%,respectively.?Nugent score:Most of them are concentrated in 4-6 points(BV intermediate type),BV(-),BV intermediate type,BV(+)accounted for 16.67%,66.66%,and 16.67%,respectively.?AV score:63 patients completed AV score,AV(+)accounted for 58.73%(37/63).?Lactobacillus grading:Grade I,Ila,?b,and ? each accounted for 3.92%,8.82%,11.76%,and 75.49%.?Cocci distribution:intravaginal cocci(-/±),(+?++),(+++?++++)accounted for 77.45%,18.63%,and 3.92%,respectively.?White blood cell count:white blood cells>10/oil mirror accounted for 50.98%,white blood celis<10/oil mirror accounted for 49.02%(50/102).?The abnormal cleanliness accounted for 95.1%(?/?+accounted for 55.88%,IV/IV+accounted for 39.22%).?Abnormal vaginal pH(pH>4.5)accounted for 90.2%.?Hydrogen peroxide(H202):79.41%of patients with vaginal secretions H202(+),lactobacillus function is basically normal.11 Leukocyte esterase:-/±,+,++,+++each accounted for 41.18%,34.31%,15.69%,8.82%,of which 58.82%of patients had vaginal inflammatory response.12 Sialidase:-,±,+,++ each accounted for 75.49%,11.76%,11.76%,0.98%.13 87.25%of patients had reduced lactobacilli,33.33%of patients had microbial inhibition,allbacteria decreased,and no dominant bacteria.(3)HR-HPV infection:HR-HPV positive rate was 92.2%;HR-HPV viral load was 0-4190.02 RLU/CO,average(484.05±785.50)RLU/CO,quartile:76.275(12.855,561.838)RLU/CO.(4)Postoperative pathology:? Pathological type:mainly squamous cell carcinoma(75.49%),followed by adenocarcinoma(accounting for 17.65%),adenosquamous carcinoma,neuroendocrine carcinoma,and point microinvasive carcinoma(not reported pathological type)each accounted for 2.94%,1.96%,1.96%.? The degree of differentiation of cancer cells:mostly moderate or medium-low differentiation.Well-differentiated carcinoma,high-medium differentiated carcinoma,moderately differentiated carcinoma,moderately-differentiated carcinoma,and poorly differentiated each accounted for 2.94%,9.80%,30.39%,38.24%,and 11.76%,and those who did not report differentiation accounted for 6.86%.?Vascular tumor thrombus:vascular cancer thrombus(-)accounted for 85.29%,vascular tumor thrombus(+)accounted for 14.71%.?The depth of interstitial invasion:the majority of the infiltrating muscle layer,the infiltrating superficial muscle laye,the infiltrating middle muscle layer,and the infiltrating deep muscle layer accounted for 15.69%,44.12%,and 35.29%,respectively.No patients with significant cancer infiltration accounted for 4.90%.?Lymph node:The metastasis rate of cancer was 17.65%.?Paragonal:No cancer metastasis was found.(5)Correlation between preoperative vaginal microecological status and HR-HPV infection.?Correlation with HR-HPV positive rate:There was a statistically significant difference in HR-HPV positive rate between patients with different intravaginal cocci(P<0.05),and the fewer cocci,the higher the positive rate of HR-HPV.The difference of HR-HPV positive rate between patients with different pH values was statistically significant(P<0.05),and the higher the pH,the higher the positive rate of HR-HPV.There was no significant difference in the positive rate of HR-HPV among the other patients with different vaginal microecological indicators(Vaginal flora concentration,vaginal flora diversity,vaginal dominant bacteria,Nugent score,AV score,Lactobacillus fractionation,G+large bacillus content,small bacillus content,white blood cell count,H202;leukocyte esterase;sialidase)(P>0.05).There was no significant difference in HR-HPV viral load between patients with other different vaginal microecological indicators(Vaginal flora concentration,vaginal flora diversity,vaginal dominant bacteria,Nugent score,Lactobacillus fractionation,G+large bacilli content,small bacillus content,pH,H202:leukocyte esterase;sialidase)(P>0.05).?Correlation with HR-HPV viral load:There was a statistically significant difference in HR-HPV viral load between patients with different AV scores(P<0.05),and the HR-HPV viral load in the AV score<3 was significantly higher than that in the AV score ? 3.There was a statistically signficant difference in HR-HPV viral load between patients with different intravaginal cocci(P<0.05),and the fewer cocci,the higher the HR-HPV viral load.There was a statistically significant difference in HR-HPV viral load between patients with different levels of leukocytes in the vagina(P<0.05),and the lower the white blood cell content,the higher the HR-HPV viral load.(6)Correlation between preoperative vaginal microecological status and clinical pathological factors of cervical cancer:The microbial population density was different,and the positive rate of lymph node cancer metastasis was statistically significant(P<0.05),and the positive rate of lymph node cancer metastasis was higher in patients with abnormal microbial population density.The leukocyte esterase content was different,and the difference of cancer interstitial infiltration depth was statistically significant(P<0.05),and the less leukocyte esterase,the shallower the interstitial infiltration depth.There were no significant differences in the clinicopathological factors between the patients with other different vaginal microecological indicators(Vaginal flora diversity,vaginal dominant bacteria,Nugent score,AV score,Lactobacillus grade,G+large bacilli content,small bacillus content,cocci content,white blood cell count,pH,H202,sialidase)(P>0.05).Conclusion(s):(1)In preoperative vaginal microecological indicators of cervical cancer patients,vaginal pH,cocci content and HR-HPV positive rate were correlated,pH increased,cocci content decreased,and HR-HPV infection increased.(2)AV score,intravaginal cocci content,white blood cell count and HR-HPV viral load were correlated.The lower the AV score,the less intravaginal cocci content,the less white blood cell count,the heavier the HR-HPV infection.(3)The microbial population density was correlated with the positive rate of lymph node cancer metastasis,and the abnormal population density may increase the lymph node metastasis rate of patients.(4)The content of leukocyte esterase is correlated with the depth of interstitial invasion.The increase of leukocyte esterase may increase the depth of interstitial invasion.(5)The remaining vaginal microecological indicators were not associated with HPV infection and clinical pathological factors. |
PDF Full Text Request