Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Department of Pathology, Peking University First Hospital, Beijing, China.
J Obstet Gynaecol Res. 2021 Feb;47(2):661-668. doi: 10.1111/jog.14578. Epub 2020 Nov 20.
The value of top-hat procedure during loop electrosurgical excision procedure (LEEP) for squamous intraepithelial lesions had remained controversial. This study aimed to evaluate whether top-hat specimens positive for cervical intraepithelial neoplasia (CIN) on histopathology can serve as an independent risk factor to predict treatment failure.
We reviewed the medical records of patients who underwent LEEP and top-hat procedures in Peking University First Hospital between 2011 and 2016 and collected their follow-up data until January 2019. We compared the pathological risk factor of treatment failure. Multivariate analysis was carried out to clarify the independent determinant of treatment failure. A Cox model was used to assess the influence of different variables on cumulative treatment failure rates.
This study included 295 cases for short-term treatment failure, and among them, 178 cases were used to study the long-term. The presence of CIN in top-hat was relevant to short-term treatment failure (OR = 9.64, 95% CI 2.55-36.4) despite a clear margin. On multivariate analysis, top-hat result (OR = 3.58, 95% CI 1.30-9.89), age ≥ 50 (OR = 10.2, 95%CI 3.64-28.3) and post-treatment HPV 16/18 infection (OR = 2.35, 95%CI 1.19-4.63) were independent risk factors in predicting short-term failure. In the Cox model, these factors were also associated with higher cumulative failure rates.
The current study supported the predictive value of top-hat procedure in short-term failure after LEEP. Typically, women with positive top-hat need closer follow-up despite their negative margin status. Older women with positive top-hat findings and HPV 16/18 infections after the treatment suffer a higher risk of short-term failure.
环行电切术（LEEP）中进行顶尖帽（top-hat）处理对于宫颈上皮内瘤变（CIN）的价值一直存在争议。本研究旨在评估组织病理学上顶尖帽标本 CIN 阳性是否可作为预测治疗失败的独立危险因素。
我们回顾了 2011 年至 2016 年期间在北京大学第一医院接受 LEEP 和顶尖帽处理的患者的病历，并收集了他们截至 2019 年 1 月的随访数据。我们比较了治疗失败的病理危险因素。进行多变量分析以明确治疗失败的独立决定因素。Cox 模型用于评估不同变量对累积治疗失败率的影响。
本研究包括 295 例短期治疗失败病例，其中 178 例用于研究长期治疗。尽管切缘清晰，但顶尖帽标本中 CIN 的存在与短期治疗失败相关（OR=9.64，95%CI 2.55-36.4）。多变量分析显示，顶尖帽结果（OR=3.58，95%CI 1.30-9.89）、年龄≥50 岁（OR=10.2，95%CI 3.64-28.3）和治疗后 HPV 16/18 感染（OR=2.35，95%CI 1.19-4.63）是预测短期失败的独立危险因素。在 Cox 模型中，这些因素也与更高的累积失败率相关。
本研究支持顶尖帽处理在 LEEP 后短期失败预测中的价值。通常，即使切缘阴性，顶尖帽阳性的女性需要更密切的随访。治疗后顶尖帽阳性且 HPV 16/18 感染的老年女性有更高的短期失败风险。
