宫颈锥切术后切缘阳性及人乳头瘤病毒持续感染的高级别宫颈发育异常的结局
Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization.
作者信息
Giannini Andrea, Di Donato Violante, Sopracordevole Francesco, Ciavattini Andrea, Ghelardi Alessandro, Vizza Enrico, D'Oria Ottavia, Simoncini Tommaso, Plotti Francesco, Casarin Jvan, Golia D'Augè Tullio, Cuccu Ilaria, Serati Maurizio, Pinelli Ciro, Bergamini Alice, Gardella Barbara, Dell'Acqua Andrea, Monti Ermelinda, Vercellini Paolo, D'Ippolito Giovanni, Aguzzoli Lorenzo, Mandato Vincenzo Dario, Giannella Luca, Scaffa Cono, Ditto Antonino, Falcone Francesca, Borghi Chiara, Malzoni Mario, Di Giovanni Alessandra, Salerno Maria Giovanna, Liberale Viola, Contino Biagio, Donfrancesco Cristina, Desiato Michele, Perrone Anna Myriam, De Iaco Pierandrea, Ferrero Simone, Sarpietro Giuseppe, Matarazzo Maria G, Cianci Antonio, Cianci Stefano, Bosio Sara, Ruisi Simona, Mosca Lavinia, Tinelli Raffaele, De Vincenzo Rosa, Zannoni Gian Franco, Ferrandina Gabriella, Petrillo Marco, Capobianco Giampiero, Carlea Annunziata, Zullo Fulvio, Muschiato Barbara, Palomba Stefano, Greggi Stefano, Spinillo Arsenio, Ghezzi Fabio, Colacurci Nicola, Angioli Roberto, Benedetti Panici Pierluigi, Muzii Ludovico, Scambia Giovanni, Raspagliesi Francesco, Bogani Giorgio
机构信息
Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Italy.
出版信息
Vaccines (Basel). 2023 Mar 18;11(3):698. doi: 10.3390/vaccines11030698.
The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervical lesions. All patients included had both positive surgical margins and experienced HPV persistence at 6 months. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). The charts of 2966 patients undergoing conization were reviewed. Among the whole population, 163 (5.5%) patients met the inclusion criteria, being at high risk due to the presence of positive surgical margins and experiencing HPV persistence. Of 163 patients included, 17 (10.4%) patients developed a CIN2+ recurrence during the 5-year follow-up. Via univariate analyses, diagnosis of CIN3 instead of CIN2 (HR: 4.88 (95%CI: 1.10, 12.41); = 0.035) and positive endocervical instead of ectocervical margins (HR: 6.44 (95%CI: 2.80, 9.65); < 0.001) were associated with increased risk of persistence/recurrence. Via multivariate analyses, only positive endocervical instead of ectocervical margins (HR: 4.56 (95%CI: 1.23, 7.95); = 0.021) were associated with worse outcomes. In this high-risk group, positive endocervical margins is the main risk factor predicting 5-year recurrence.
这项工作的目的是评估因高级别宫颈病变接受锥切术的患者的5年预后情况，这些病变同时呈现为HPV感染持续存在和手术切缘阳性的风险因素。这是一项回顾性研究，评估因高级别宫颈病变接受锥切术的患者。纳入的所有患者手术切缘均为阳性且在6个月时出现HPV持续感染。采用Cox比例风险回归评估相关性，并使用风险比（HR）进行总结。回顾了2966例接受锥切术患者的病历。在总体人群中，163例（5.5%）患者符合纳入标准，因手术切缘阳性和HPV持续感染而处于高风险。在纳入的163例患者中，17例（10.4%）患者在5年随访期间出现CIN2+复发。通过单因素分析，CIN3而非CIN2的诊断（HR：4.88（95%CI：1.10，12.41）；P = 0.035）以及宫颈管切缘阳性而非宫颈外口切缘阳性（HR：6.44（95%CI：2.80，9.65）；P < 0.001）与持续/复发风险增加相关。通过多因素分析，只有宫颈管切缘阳性而非宫颈外口切缘阳性（HR：4.56（95%CI：1.23，7.95）；P = 0.021）与更差的预后相关。在这个高风险组中，宫颈管切缘阳性是预测5年复发的主要风险因素。
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