Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China.
Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.
Medicine (Baltimore). 2021 Jul 9;100(27):e26359. doi: 10.1097/MD.0000000000026359.
This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization.Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data.After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317-3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598-12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952-6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence.For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.
本研究旨在确定行宫颈锥切术后高级别宫颈上皮内瘤变（CIN）患者复发的预测因素。本回顾性研究共纳入 415 例 CIN≥Ⅱ级行环形电切术（LEEP）或冷刀锥切术（CKC）的患者。采用 Cox 比例风险模型估计术后复发与临床病理数据之间的关联的风险比（HR）和 95%置信区间（CI）。在（21.48±5.82）个月的平均随访后，415 例中有 90 例（21.69%）在宫颈锥切术后发生复发。术后复发的影响因素包括足月产次数、早产史、流产史、阳性切缘、锥体长、宽、深、吸烟史和合并症史（P<.05）。多因素 Cox 模型表明阳性切缘（HR=2.144，95%CI：1.317-3.492，P<.05）、早产史（HR=4.515，95%CI：1.598-12.754，P<.05）、合并症史（HR=3.552，95%CI：1.952-6.462，P<.05）是宫颈锥切术后复发的独立危险因素。限制立方图显示锥体长>0.5cm是术后复发的保护因素。对于行宫颈锥切术后的高级别 CIN 患者，阳性切缘、早产史和合并症与复发风险增加相关，而锥体长（>0.5cm）与复发风险降低相关。
