| Objective:Explore the characteristics and influencing factors of cervical lesions in middleaged and old women and find the difficulties of cervical screening and the choice of treatment methods,so as to enrich clinical data for the prevention,screening,early diagnosis and standard of care of cervical lesions in middle-aged and old women.Methods:A total of 1040 patients with cervical lesions who were diagnosed before or during hospitalization in the First Hospital of Jilin University from August 2018 to October2020 and did not receive primary prevention of HPV vaccine were included in this study.According to the age classification standard of the World Health Organization(WHO)in 2001,middle-aged and elderly patients(≥45 years old)were selected as the study group,while young patients(≤44 years old)were selected as the control group.Retrospectively analyze with case-control method the clinical data characteristics of middle-aged and elderly women with cervical lesions,to study characteristics and prevalence of cervical lesions in middle-aged and elderly women and find the HPV infection status and other related factors,the screening characteristics and clinical characteristics of cervical lesions in middle-aged and elderly women,and to explore the selection of appropriate treatment options for different levels of cervical lesions in middle-aged and elderly women.Results:1.Study on characteristics and prevalence of cervical lesions in middle-aged and elderly women(1)Among the 1040 hospitalized patients with cervical lesions,the middle and elderly group with low-grade cervical lesions(LSIL)accounted for 11.8%;High grade cervical lesions(HSIL)accounted for 54.5%;Cervical cancer patients accounted for 33.7%.In the young group,the rates were 5.8%,78.9% and 15.4%,respectively.There was a difference in disease composition between the two groups(P<0.05).(2)The mean age of cervical LSIL patients was 47.45±11.43 years,and the median age was 49 years.The mean age of cervical HSIL was 41.78±10.98,and the median was 41 years.The mean age of cervical cancer was 48.75±10.93 years old,and the median age of onset was 50 years old.The average age of cervical cancer was significantly higher than that of cervical HSIL,P <0.05,there was a statistical difference.The results showed that cervical cancer mainly occurred in the middleaged group,cervical HSIL mostly occurred in the relatively young female group,and cervical LSIL was mainly hospitalized in the middle-aged group.2.Study on related factors of cervical lesions in middle-aged and elderly women(1)The middle-aged and elderly patients with cervical lesions(159/241)accounted for 66% of obese patients,among which 32.70%(52/159)were cervical cancer patients and 47.80%(76/159)were HSIL patients,the combined value of the two was 80.5%.In young obese patients with cervical lesions,71.95%(59/82 cases)had HSIL and 19.51%(16/82 cases)had cervical cancer.The statistical difference between the two groups was P<0.05.(2)There was no close correlation between the severity of cervical lesions and the levels of endocrine FSH,LH and E2 in middle-aged and elderly women(3)With the increase of the number of deliveries,the proportion of cervical cancer patients in middle-aged and elderly cervical lesions also increased,P<0.05.Cervical cancer accounted for 25.5% in the fertility group,and cervical squamous epithelial high-grade lesions were the most significant(76.7%)in the non-fertility group.The proportion of cervical cancer was the most significant in middle-aged and elderly patients without cervical lesions,accounting for 55.6%,while the proportion of cervical squamous high-grade lesions in young patients without cervical lesions was the most significant,accounting for 76.5%,P<0.05.3.Screening of cervical lesions in middle-aged and elderly women(1)Among 1040 patients with cervical lesions,1020 were tested for HPV,and the HPV infection rate was 88.04%(898/1020).The HPV infection rate of the young group was 89.29%(459/514 cases),and that of the elderly group was 87.74%(444/506 cases),P>0.05,there was no statistical difference.The HPV infection rate of low-grade cervical lesions(LSIL)was 83.33%(25/30),and the HPV infection rate of high-grade cervical lesions(HSIL)was 88.64%(359/405),and the HPV infection rate of cervical cancer was 88.60%(70/79)in the young group,P>0.05,there was no statistical difference.The HPV infection rate of low-grade cervical lesions(LSIL)was70.49%(43/61 cases),and the HPV infection rate of high-grade cervical lesions(HSIL)was 87.18%(245/281 cases),and the HPV infection rate of cervical cancer was 95.12%(156/164 cases)in the middle-aged and elderly group,with statistical difference(P<0.05).(2)There was no statistical difference in the subtypes of HPV infection between middle-aged and elderly patients and young patients with cervical lesions,and the majority of HPV was single type infection,accounting for 73.8%,and mixed type infection accounted for 26.2%.HPV16 was the most common subtype of HPV infection,followed by HPV58.The HPV18 was ranked fifth.There were statistical differences in HPV infection subtypes among middle-aged and elderly women with different types of cervical lesions: The most common subtypes of HPV infection in cervical cancer were HPV16 and HPV18,and HPV58 ranked the third,while the most common subtypes of HPV infection in cervical HSIL were HPV16 and HPV58,and mixed type infection was the most common in cervical LSIL,P<0.05.The results of HPV-HC2 test showed that there was a positive correlation between HPV viral load and the malignant degree of cervical lesions r=0.143,P<0.05.(3)Among the patients with cervical lesions,the cytological positive rate was48.78% for low-grade cervical squamous lesions,69.71% for high-grade cervical squamous lesions,and up to 82.8% for cervical cancer,P<0.05,indicating that there was statistical difference in cytological positive rate for different levels of cervical lesions,and the cytological positive rate was higher with the exacerbation of cervical lesions.The cytological positive rate of low-grade cervical squamous lesion was48.1%,high-grade cervical squamous lesion was 72.3%,and cervical cancer was83.2%(P<0.05)in middle-aged and elderly women with cervical lesions.(4)Colposcopy examination of cervical lesions showed that the incidence of cervical cancer was mainly concentrated in the transformation zone of type III(50.60%),while the low grade cervical squamous epithelial lesions and high grade cervical squamous epithelial lesions were mainly concentrated in the transformation zone of type(40.91%,36.99%),P<0.05.In the young patients with cervical lesions,the proportion of high-grade cervical lesions in the II transformation zone was the highest,P<0.05,showing a statistical difference.Although the proportion of cervical cancer in the transformation area of Ⅲ type was relatively high in middle-aged and elderly patients with cervical disease,the P>0.05 showed no statistical difference.4.Comparison of clinical features of different cervical lesions in middleaged and elderly women(1)Among middle-aged and elderly patients with cervical lesions,the incidence of abnormal secretions in cervical cancer patients(61.5%)was significantly higher than that in young patients(34.38%),P <0.05;Among them,76.42% were bloody secretions.The rate of abnormal secretions in cervical malignant tumors(51.39%)was significantly higher than that in LSIL(24.44%)and HSIL(19.02%),P<0.05.The rate of bloody secretions in cervical malignant tumors was high,and the rate of yellow secretions in cervical HSIL was the highest(P <0.05).(2)In the elderly group,40.7%(211/519 cases)had abnormal vaginal bleeding(LSIL 24.56%);HSIL 17.67%;Cervical cancer 74.86%.The rate of abnormal vaginal bleeding in cervical cancer was significantly higher than that in LSIL and HSIL(P<0.05).The rate of abnormal vaginal bleeding in the elderly group(HSIL+ cervical cancer)was 92.5%,which was higher than that in the young group(85.9%).(3)In patients with cervical lesions in the middle and elderly group,the most common cervical morphological abnormalities in patients with cervical malignant tumors were easily bleeding on cervical touch and vegetable pattern masses,and cervical hypertrophy was most common in cervical LSIL and HSIL.(4)The diagnostic value of vaginal ultrasonography for cervical malignancy is as high as 75%.There were 181 positive cases of vaginal ultrasonography in middleaged and elderly patients with cervical lesions,and 118 cases in young group.The positive rate of vaginal ultrasonography in different age groups with various cervical lesions was statistically different(P <0.001).The rate of cervical cancer was 71.3%(129/181)in the middle aged and elderly patients with positive ultrasound diagnosis.The incidence of HSIL in cervical lesions in the young group was 52.54%.5.Selection of treatment schemes for different types of cervical lesions in middle-aged and elderly women(1)Total hysterectomy was performed in 31.5% of the elderly patients with lower cervical lesions,and cervical LEEP was performed in 69.6% of the young patients without hysterectomy(P <0.05).Total hysterectomy was performed on the cervical HSIL in the middle and elderly group(45.8%),significantly higher than that in the young group(3.5%).Compared with the younger group(85.8%),the elderly group chose cold knife coning for cervical HSIL(46.6%),and the difference between the two groups was significant(P <0.001).(2)Both the middle-aged and the elderly and the young groups were more likely to adopt simple radical resection for cervical cancer,but the proportion of postoperative radiotherapy and chemotherapy in the middle-aged and the elderly group was significantly higher than that in the young group,and there was a statistical difference in the treatment methods between the two groups(P <0.001).(3)Preoperative and postoperative pathological diagnosis of cervical lesions were inconsistent.There were statistical differences in the pathological grade changes of high-grade cervical lesions in different age groups before and after surgery,and the proportion of grade improvement in the elderly group was higher than that in the young group,P <0.001.And the phenomenon of "lesion in cervical canal" in patients with high-grade lesions,and the elderly group was higher than the young group(P<0.05).Changing outcomes alter treatment patterns.Conclusion:1.With the increase of age,the incidence rate of cervical lesions also increased. The risk of cervical cancer in middle-aged and elderly women is significantly higher than that in the younger group,and the severity of cervical lesions may be affected by childbirth.Cervical HSIL occurs more often in relatively young women.2.The cervical lesions of middle-aged and elderly women still have a high rate of HPV infection due to the absence of primary protection of HPV vaccine,and persistent infection such as HPV16/18 and HPV58 is still a high-risk factor.HPV combined with cell testing is particularly important.3.Middle-aged and older women are at greater risk of cervical disease in the area of cervical type III transformation.Transvaginal ultrasonography can improve the early diagnosis of cervical cancer.4.Timely and appropriate treatment of persistent cervical LSIL in middle-aged and elderly women may stop the progression of cervical cancer as soon as possible.Middle-aged and elderly women cervical lesions should choose a variety of comprehensive and appropriate treatment modes. |
PDF Full Text Request