Analysis Of Residual And Recurrence Of Cervical Carcinoma With High Level Squamous Intrae Pithelial Lesions

Objective:The Pur Pose of this study was to explore the relapse or residual causes of HSIL patients by analyzing the basic data,intraoperative conditions,postoperative pathological results and postoperative follow-up data of patients who underwent cold knife conization(CKC).To provide guidance for the management of patients with high risk factors after CKC,strengthen the vigilance of clinicians and high risk Patients,so as to effectively carry out follow-up and education of postoperative patients,effectively control the development of cervical HSIL to cervical infiltration cancer,and reduce the incidence and mortality of cervical cancer.Methods:A total of 318 patients with complete clinical data from January 1,2019 to December 31,2020 who were admitted to Hebei North University Outpatient of the First Hospital(Grade A General Hospital)due to"CINII and CINIII"for CKC,received HSIL preoperatively and pathologically after surgery and completed 2-year follow-up were selected as the study subjects.The clinical data and follow-up results were analyzed.HPV infection classification(16,18/45,other high-risk and negative types),TCT grade,whether the lesion involved,whether the internal and external margin is positive,whether the lesion adjacent to the incision edge;lesion scope,conization depth,HPV continuous positive,age,parturition,menopause status and other data were statistically analyzed to explore the HSIL patients with cervical CKC residual focus and relapse related factors.Results:From January 1,2019 to December 31,2020,318 patients with advanced cervical squamous intraepithelial lesions treated with CKC in our hospital and meeting the aforesaid conditions,among whom 39 patients showed residual lesions or recurrence during follow-up,and 7 cases were found residual within six months,accounting for 2.20%of the total number;10 cases recurred within 6 to 12 months,accounting for 3.14%of the total number;and 22 cases recurred within 12 to 24 months,accounting for6.91%of the total number.1.The general situation of the two groups was analyzed by Chi-square test.The results showed:age(X~2=4.514,P=0.034),menopausal status(X~2=5.994,P=0.014),TCT level(X~2=5.121,P=0.024),range of lesions(X~2=4.055,P=0.044),gland involvement(X~2=5.639,P=0.018),margin Positive(X~2=38.081,P<0.001),lesion adjacent margin(X~2=4.027,P=0.045),cervical HPV continuous Positive(X~2=10.214,P=0.001),which were statistically significant between the positive group and the vaginal group(P<0.05).There was no significant difference between the two groups in the Number of regnancies and births,HPV type and conization depth.2.Logistic regression analysis of single factor showed that age≥40(P=0.037,OR=0.457),meno Pause(P=0.024,OR=0.421),preoperative cytology≥HSIL(P=0.026,OR=1.262),lesion involvement(P=0.021,OR=2.516),positive resection edge(P<0.001,OR=8.215),lesion adjacent incision edge(P=0.048,OR=2.017),lesion extent(P=0.047,OR=2.043),persistent positive HPV of cervix(P=0.002,OR=0.333)had correlation with residual or recurrence of CKC patients.3.Multivariate Logistic regression analysis results are as follows:Age,preoperative TCT level,persistent infection of cervical HPV,positive margin of incision,and range of lesions were independent risk factors for survival and recurrence of cervical CKC.(1)Age≥40(P=0.041,OR=1.930,95%CI 1.082-2.514);(2)Preo Perative TCT≥HSIL(P=0.044,OR=1.919,95%CI1.964-3.821);(3)Continued Positive HPV in the cervi X(P=0.004,OR=2.792,95%CI 1.380-5.649);(4)Positive cut edge(P<0.001,OR=7.427,95%CI 3.447-16.002);(5)The lesion range≥3 quadrants(P=0.028,OR=2.566,95%CI1.110-5.933).Conclusion:1.The age of the patient is related to the residual and recurrence after cervical CKC,which is the risk factor;2.Positive margin and lesion range were independent risk factors of CIN residue and recurrence after cervical CKC.3.Preoperative TCT and Hp V were independent risk factors of SIL residual and recurrence after cervical CKC.4.Patients with any single risk factor after cervical CKC should be given a specific follow-up protocol and actively intervene.More attention should be paid to the patients with multiple risk factors.