Comparative Study Of Clinical Efficacy And Regression Of HPV After LEEP And CKC In Patients With HSIL And Analysis Of Factors Associated With Persistent HPV Infection After Surgery

Research objectives:To study the clinical efficacy,regression of high-risk human papillomavirus(HR-HPV)and factors associated with persistent HR-HPV infection after cervical cold kni fe conization(CKC)and cervical loop electrosurgery(LEEP)for the treatment of high-grade squamous intraepithelial lesions(HSIL)of the cervix.Methods:The data of patients who underwent cervical conization for HSIL at The Third A ffiliated Hospital of Guangzhou Medical University from January 2018 to December2021 were retrieved through the case lending system,including patients’ age,hospital days,hospital costs,whether they had bleeding after intercourse,menopausal status,pregnancy and delivery,preoperative HPV typing,preoperative TCT results,colposco py results,intraoperative bleeding,and The patients were divided into two groups acc ording to the surgical method: CKC group(93 patients)for cold knife conization of th e cervix and LEEP group(197 patients)for loop electrosurgery of the cervix.The clin ical efficacy,regression of HR-HPV and factors associated with persistent HR-HPV in fection after surgery were analyzed in the two groups.Results:1.Comparison of general condition and surgical data between the two groups:(1)there was no statistical significance between the two groups in terms of age,number of pregnancies and deliveries,post-operative bleeding,menopausal status,type of pre operative HPV infection,and preoperative TCT results.There was a statistically signif icant difference between the two groups in the age at menarche,P < 0.05.The results of preoperative colposcopy in the two groups showed that there were fewer patients w ith CIN 2 in the CKC group than in the LEEP group,and more patients with CIN 3 in the CKC group than in the LEEP group,with statistically significant differences betw een the two groups at P < 0.05.(2)The intraoperative blood loss,length of operation,depth of conization,and width were greater in the CKC group than in the LEEP group and were statistically significant with a p value < 0.05.(3)There was no statistical sig nificance between the two groups in terms of positive surgical margins of the specime n,supplementary surgery after surgery,involvement of the gland by the lesion,or occ urrence of secondary bleeding after surgery(P > 0.05).However,the CKC group had more days and hospital costs than the LEEP group,which was statistically significant at P < 0.05.There was no statistical significance between the two groups in patients w ith postoperative pathological findings suggestive of nilm,cin1,and Cin2,P > 0.05.A nd patients with postoperative pathology of CIN3 had more CKC group than LEEP gr oup,and there was statistical significance between the two groups,P < 0.05.2.Analysis of the HPV seroconversion rate between the two groups,the HPV ser oconversion rates were 82.8% and 80.6% in the CKC group at postoperative month 3and 12,respectively,and 75.6% and 78.7% in the LEEP group,respectively,and the H PV seroconversion rate between postoperative month 3 and 12 in the CKC group was greater than that in the LEEP group,but there was no statistical difference between th e two groups,P > 0.05.The HPV transamination rate was 87.1% in the CKC group an d 76.6% in the LEEP group at postoperative month 6.The HPV transamination rate at postoperative month 6 in the CKC group was also greater than that in the LEEP grou p,but there was a statistical difference between the two groups,P < 0.05.3.Analysis of the rate of postoperative HPV persistent infection in the two group s: the rate of postoperative HPV persistent infection in the CKC group was smaller tha n that in the LEEP group at 3,6,and 12 months,and the rate of persistent infection in both groups tended to decrease over time,but there was no statistical difference in the rate of postoperative HPV persistent infection between the two groups,P > 0.05.4.According to the persistent infection rate of postoperative HPV,it can be seen t hat the rate of persistent infection decreased over time,and by univariate analysis of HPV persistent infection at 1 year after surgery,it was statistically significant between persistent infection of HPV and preoperative HPV typing and surgical specimen marg in positivity.There was no statistical significance between the type of surgical proced ure,the presence or absence of post coital bleeding,menopausal status,whether the le sion involved the gland,whether the procedure was supplemented,age,number of pre gnancies and deliveries,extent of surgery with conization,age at menarche,preoperati ve TCT classification,colposcopic pathology results,and postoperative pathology res ults.To evaluate the possible risk factors,we further did multivariate logistic regressio n analysis,and concluded that preoperative HPV type 16 coinfection with 12 other HP V types(OR 8.22;95% CI 2.69-25.10;P = 0.001),lesion involvement of gland(OR 0.39;95% CI 0.18-0.86;P = 0.019),and positive surgical specimen margins(OR 3.63;95% CI 1.26-10.42;P = 0.017)were independent risk factors for HPV persistence.Conclusion:1.The patients with HSIL underwent either CKC or LEEP to clear HPV infection effectively,and the CKC group had the highest clearance rate at 6 months after surger y and had a statistical difference with the LEEP group,P < 0.05.However,LEEP has several advantages over CKC surgery such as shorter duration of surgery,fewer hospit al days,lower medical costs,and less intraoperative bleeding.CKC has a higher rate o f HPV clearance,lower rate of positive postoperative margins,and lower rate of persis tent postoperative HPV infection than LEEP.2.Found that HPV16 and 12 other HPV types preoperatively,positive postoperat ive margins,and specimens showing glandular involvement were high risk factors for HPV persistence 1 year after conization.