Sun Xiaoqi, Lei Huifang, Xie Xiaoyan, Ruan Guanyu, An Jian, Sun Pengming
Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
Int J Gen Med. 2020 Nov 10;13:1067-1074. doi: 10.2147/IJGM.S280576. eCollection 2020.
Post-menopausal patients with cervical intraepithelial neoplasia (CIN) have a high rate of residual or recurrent lesions after treatment, and their risk for cervical cancer later in life is higher than the general population. Hence, management for this specific group of post-menopausal patients needs more attention.
The study aimed to identify risk factors associated with the presence of residual disease in hysterectomy specimens in post-menopausal patients with cervical intraepithelial neoplasia grade 3 (CIN 3).
This study was a retrospective analysis of data from post-menopausal women who had undergone hysterectomy following conization for CIN 3 from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, parity, Thinprep cytology results, human papillomavirus (HPV) genotype, biopsy results, pre-cone endocervical curettage (ECC) results, conization method, operating surgeon, cone dimension, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with residual disease in hysterectomy specimens.
Analysis of data from 129 women was performed. The proportion of residual disease was 43.41% overall. A higher grade according to colposcopy biopsy, abnormal pre-cone ECC results, the cone method (LEEP vs CKC), a cone volume >1.57 cm, and positive margins in conization specimens were found to be significantly associated with residual lesions on univariable analysis. After multivariate analysis, only an abnormal pre-cone ECC result (odds ratio 3.99; 95% confidence interval (CI) 1.41-11.33; p = 0.009) remained significant.
The rate of residual lesions in uterine specimens was high regardless of the cone margin status in post-menopausal women with CIN 3. Risk-based strategies are needed to identify patients who have abnormal pre-cone ECC results, and definitive treatment with hysterectomy should be considered in post-menopausal patients with an elevated risk for residual lesions.
绝经后宫颈上皮内瘤变（CIN）患者治疗后残留或复发病变的发生率较高，且其日后患宫颈癌的风险高于一般人群。因此，针对这一特定绝经后患者群体的管理需要更多关注。
本研究旨在确定绝经后3级宫颈上皮内瘤变（CIN 3）患者子宫切除标本中与残留疾病存在相关的危险因素。
本研究对2012年至2018年在福建省妇幼保健院因CIN 3行锥切术后接受子宫切除术的绝经后女性的数据进行回顾性分析。从数据库中提取的因素包括年龄、产次、薄层液基细胞学检查结果、人乳头瘤病毒（HPV）基因型、活检结果、锥切术前宫颈管搔刮术（ECC）结果、锥切方法、手术医生、锥切尺寸、切缘状态和腺体受累情况。进行单因素和多因素分析以确定子宫切除标本中与残留疾病相关的危险因素。
对129名女性的数据进行了分析。总体残留疾病比例为43.41%。单因素分析发现，阴道镜活检分级较高、锥切术前ECC结果异常、锥切方法（环形电切术与冷刀锥切术）、锥切体积>1.57 cm以及锥切标本切缘阳性与残留病变显著相关。多因素分析后，仅锥切术前ECC结果异常（比值比3.99；95%置信区间（CI）1.41 - 11.33；p = 0.009）仍具有显著性。
无论切缘状态如何，绝经后CIN 3患者子宫标本中残留病变的发生率都很高。需要基于风险的策略来识别锥切术前ECC结果异常的患者，对于残留病变风险较高的绝经后患者应考虑行子宫切除术进行确定性治疗。
