Related Factors Analysis Of Occult Cervical Cancer

Objective:Occult cervical cancer（OCC）refers to invasive cervical cancer diagnosed by cervical conization or total hysterectomy but the histo pathology of cervical biopsy and endocervical curettage（ECC）fail to diagnose^[1].This study retrospectively analyzed the clinical data of patients with occult cervical cancer and studied its related factors in order to reduce the missed diagnosis rate of occult cervical cancer.Methods:210 patients with occult cervical cancer who were admitted to the department of gynecology in our hospital（the Second Hospital of Jilin University）from January 2016 to December 2020 were collected,comparing with 184 patients whose pathology were not upgraded to cervical cancer after surgery.The clinical data were collected,mainly including:age,pregnancy,parity,mode of delivery,menstrual condition,clinical symptoms,duration of clinical symptoms,thin prep cytology test（TCT）results,human papilloma Virus（human papilloma virus,HPV）results,transformation zone type,colposcopy impression,squamous cell carcinoma antigen（SCCA）,cervical biopsy pathological results,postoperative pathological results,intraoperative frozen pathology and other related factors.SPSS 24.0 software was used for statistical analysis.We used chi-square test and rank sum test for univariate analysis,withα=0.05 as the test level,which means when P<0.05,the difference was considered statistically significant.We analysed the statistically significant univariate factors and the independent influencing factors.We compared intraoperative frozen pathology with postoperative routine pathology,analyzed their consistency and related influencing factors.Results:1.394 patients were included in this study,separating into two groups:184 patients in the non-upgraded postoperative pathology group（control group）and 210 patients with occult cervical cancer（experimental group）.Occult cervical cancer is mainly in stage IA1 and IB1.2.The average age of patients with occult cervical cancer was 46.99years old,while the control group was 39.86.According to stratified analysis,the patients of occult cervical cancer were mostly 41-50 years old,and the control group was mostly 31-40 years old.The difference was statistically significant.The average number of pregnancy of experimental group was 2.06±0.813,and the average parity was 1.33±0.665.The average number of pregnancy of control group was 1.77±0.798,while the average parity was 1.08±0.697.The average pregnancy and parity of former group were greater than those of the control group,and the difference was statistically significant.3.Most of the patients in both groups had one vaginal delivery.In experimental group,it accounted for 54.8%,while 50%in control group.The difference was statistically significant.The difference of cesarean sections wasn’t statistically significant.62.4%of experimental group were postmenopausal,while 13.0%of the control group were postmenopausal.The difference was statistically significant.38.1%of patients with occult cervical cancer had contact bleeding,but 56.2%of patients had no clinical manifestations.Patients with abnormal SCCA in experimental group were more than the other group.Compared with the control group,the difference was statistically significant.4.HSIL was the most common TCT in patients of occult cervical cancer,accounting for 21.9%,while NILM is 32.1%in the control group,with a statistically significant difference.204 patients of experimental group were HPV positive,with 55.2%infected with HPV 16/18.Compared with the control group,the chi-square test showed a statistically significant difference（P<0.01）.The transformation zone were mainly type III in both groups,among which the experimental group accounted for 63.3%and the control group accounted for 50.0%.The experimental group was more than the control group,and the difference was statistically significant.For colposcopy,HSIL accounted for the largest part in two groups,but the experimental group was more than the control group.The difference was statistically significant（P<0.001）.58.6%of experimental group involved glands in cervical biopsy,while62.0%of the control group.It had no significant difference in chi-square test analysis.5.Binary multivariate logistic analysis showed that contact bleeding,SCCA≥1.5μg/L,HPV16/18 infection and type 3 transformation zone were the independent influencing factors of occult cervical cancer.6.Among 210 patients of occult cervical cancer,85 patients had frozen pathology examination.The coincidence rate between intrao-perative frozen pathology and postoperative pathology was 75.3%（64/85）.73.3%of patients of negative,suspicious or unexcluded cancer by intraoperative frozen pathology were stage IA1.7.The most common supplementary surgery is cervical conization+total hysterectomy,cervical conization+total hysterectomy+pelvic lymphadenectomy.Conclusions.1.Factors that affect occult cervical cancer include age,pregnancy,parity,vaginal delivery,menopausal status,clinical symptoms,SCCA,TCT results,HPV infection type,type of transformation zone,and colposcopy diagnosis.Independent influencing factors for occult cervical cancer are contact bleeding,blood SCCA≥1.5μg/L and type 3transformation zone.2.The consistency of intraoperative frozen pathology and postoperative pathology is 75.3%.Factors that affect intraoperative frozen pathology are:（1）limited or thick slices;（2）blurry details of freezing artifacts;（3）tissues are stale or fixed prior to sectioning;（4）inexperienced physicians make wrong samples and misdiagnoses（5）The nature of the lesion and the lack of specific targets for tissue fragmentation.3.For patients of postoperative pathological upgrading to cervical cancer,secondary surgery,radiotherapy or concurrent radiotherapy and chemotherapy are often required.