[宫颈上皮内瘤变和微浸润性宫颈癌患者锥切术后宫颈残留病变的预测因素]

[Predictors of residual lesion in cervix after conization in patients with cervical intraepithelial neoplasia and microinvasive cervical cancer].

作者信息

Tan Xian-Jie, Wu Ming, Lang Jing-He, Ma Shui-Qing, Shen Keng, Yang Jiaxin

机构信息

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Jan 6;89(1):17-20.

PMID:19489237

Abstract

OBJECTIVE

To determine the clinicopathological factors predicting residual lesions after conization in patients with cervical intraepithelial neoplasia (CIN) and microinvasive carcinoma of cervix (MIC).

METHODS

The clinical data of 77 patients with CIN3, 20 patients with stage Ia1 cervical cancer, and 8 patients with stage 1a2 cervical cancer, totally 105 patients, aged (43 + 6), who received further surgery within 3 months after conization, 95 receiving hysterectomy, 2 receiving repeated conization, and 8 receiving radical hysterectomy and pelvic lymph node dissection, were evaluated. The demographic features, clinical and pathological parameters, and the correlation thereof with the post-conization residual lesions were analyzed retrospectively.

RESULTS

Residual lesions were found in the specimens obtained from hysterectomy or repeated conization of 53 of the 105 patients (50.5%), among which 38 were CIN2 or less severe lesions. Univariate analysis showed that menopausal status, procreation status, cervical cytology, method of conization, and range of resection were not correlated with the presence of post-conization residual lesion, while age < or = 45 (P < 0.05, odd ratio [OR] = 4.68) and positive resection margin (P < 0.05, OR = 5.40) were risk factors of residual lesion. There were no differences in the proportion of post-conization residual lesion among the patients with MIC, CIN 3, CIN2 or less severe lesions. Multivariate logistic analysis showed that only the positive resection margin was an independent risk factor of residual lesion after conization (P < 0.05, OR = 4.20).

CONCLUSIONS

Although severity of the cervical disease is the most important factor in determining post-conization treatment, it is not a predicting factor for post-conization residual lesion. Only the positive resection margin was an independent risk factor of residual lesion after conization.

摘要

目的

确定预测宫颈上皮内瘤变（CIN）和宫颈微浸润癌（MIC）患者锥切术后残留病变的临床病理因素。

方法

评估105例患者的临床资料，其中77例CIN3患者、20例Ia1期宫颈癌患者和8例Ia2期宫颈癌患者，年龄（43±6）岁，在锥切术后3个月内接受进一步手术，95例行子宫切除术，2例行再次锥切术，8例行根治性子宫切除术及盆腔淋巴结清扫术。回顾性分析人口统计学特征、临床和病理参数及其与锥切术后残留病变的相关性。

结果

105例患者中，53例（50.5%）子宫切除或再次锥切标本中发现残留病变，其中38例为CIN2或更轻病变。单因素分析显示，绝经状态、生育状态、宫颈细胞学、锥切方法和切除范围与锥切术后残留病变的存在无关，而年龄≤45岁（P<0.05，比值比[OR]=4.68）和切缘阳性（P<0.05，OR=5.40）是残留病变的危险因素。MIC、CIN 3、CIN2或更轻病变患者锥切术后残留病变比例无差异。多因素logistic分析显示，只有切缘阳性是锥切术后残留病变的独立危险因素（P<0.05，OR=4.20）。