Guo Yulin, Wang Ying, Peng Qiuzi, Li Lu, Zou Miao, Wang Chaonan, Wu Xufeng, Ma Quanfu
Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China.
Hubei Clinical Medical Research Center for Gynecologic Malignancy, Wuhan, China.
Front Oncol. 2022 Sep 14;12:980884. doi: 10.3389/fonc.2022.980884. eCollection 2022.
Few studies have investigated the absence of high-grade cervical intraepithelial neoplasia (CIN) in excised specimens, and sample sizes of these studies were limited. This study retrospectively analyzed clinical characteristics of 1695 patients with CIN 2/3 to determine the incidence rate and relative factors of CIN 1 or less in conization specimens from patients with colposcopic biopsy-confirmed CIN 2/3. The study group comprised 430 cases of CIN 1 or less in conization specimens, and the control group comprised 1142 cases with high-grade CIN lesions in conization specimens. Univariate and multivariate logistic regression models were established to evaluate relative factors. The 1-9 years follow-up data were analyzed to determine the persistence/recurrence rate. Multivariate logistic regression showed that patients aged 18-24 years (OR (95% CI) = 2.224 (1.014, 4.877)); with a negative hrHPV test result (OR (95% CI) = 3.210 (1.627, 6.331)); a cytology test result of normal (OR (95% CI) = 5.184 (3.138, 8.563)), ASC-US (OR (95% CI) = 3.420 (2.102, 5.564)), LSIL (OR (95% CI) = 2.588 (1.475, 4.541)), or ASC-H (OR (95% CI) = 2.434 (1.306, 4.539)); an indication of CIN 2 on biopsy (OR (95% CI) = 2.290 (1.694, 3.096)), and no glandular involvement (OR (95% CI) = 1.616 (1.205, 2.169)) were more likely to have an absence of high-grade dysplasia in conization specimens. There was no difference in the persistence/recurrence rate between the two groups (x2 = 1.55, P = 0.46). An age of 18-24 years, a negative hrHPV test result, a non-HSIL cytology test result, an indication of CIN 2 on biopsy, and no glandular involvement were relative factors for an absence of high-grade dysplasia in conization specimens. For patients with relative factors, especially young women, informed follow-up should be considered.
很少有研究调查切除标本中不存在高级别宫颈上皮内瘤变（CIN）的情况，且这些研究的样本量有限。本研究回顾性分析了1695例CIN 2/3患者的临床特征，以确定在阴道镜活检确诊为CIN 2/3的患者锥切标本中CIN 1及以下病变的发生率和相关因素。研究组包括锥切标本中CIN 1及以下病变430例，对照组包括锥切标本中高级别CIN病变1142例。建立单因素和多因素逻辑回归模型以评估相关因素。分析1 - 9年的随访数据以确定持续/复发率。多因素逻辑回归显示，年龄在18 - 24岁的患者（OR（95%CI）= 2.224（1.014，4.877））；高危型人乳头瘤病毒（hrHPV）检测结果为阴性的患者（OR（95%CI）= 3.210（1.627，6.331））；细胞学检查结果为正常的患者（OR（95%CI）= 5.184（3.138，8.563））、意义不明确的非典型鳞状细胞（ASC-US）（OR（95%CI）= 3.420（2.102，5.564））、低级别鳞状上皮内病变（LSIL）（OR（95%CI）= 2.588（1.475，4.541））或非典型鳞状细胞不排除高级别鳞状上皮内病变（ASC-H）（OR（95%CI）= 2.434（1.306，4.539））；活检提示CIN 2的患者（OR（95%CI）= 2.290（1.694，3.096）），且无腺体受累的患者（OR（95%CI）= 1.616（1.205，2.169））在锥切标本中更有可能不存在高级别发育异常。两组之间的持续/复发率无差异（x2 = 1.55，P = 0.46）。年龄18 - 24岁、hrHPV检测结果为阴性、非高级别鳞状上皮内病变（HSIL）细胞学检查结果、活检提示CIN 2以及无腺体受累是锥切标本中不存在高级别发育异常的相关因素。对于有相关因素的患者，尤其是年轻女性，应考虑进行知情随访。
