宫颈锥切术后 CIN3 级宫颈活检的病理升级相关因素分析。
Analysis of related factors for pathological upgrading of cervical biopsy from CIN3 to cancer after conical resection.
机构信息
Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China.
The Second Affiliated Hospital of Anhui Medical University, Anqing, Anhui Province, P.R. China.
出版信息
BMC Cancer. 2024 Apr 1;24(1):401. doi: 10.1186/s12885-024-12186-w.
BACKGROUND
To investigate related factors for postoperative pathological upgrading of cervical biopsy to cervical cancer (CC) in patients with cervical intraepithelial neoplasia (CIN)3 after conical resection.
METHODS
This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author's Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis.
RESULTS
Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86-0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38-5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91-7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69-0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection.
CONCLUSION
Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
背景
探讨宫颈锥切术后宫颈上皮内瘤变（CIN）3 患者术后病理升级为宫颈癌（CC）的相关因素。
方法
本回顾性研究收集了作者医院 2012 年 1 月至 2022 年 12 月期间经宫颈活检诊断为 CIN3 的患者数据。主要结局为患者锥切术后的病理结果。如果术后病理提示 CC，则将病理发现归类为病理升级组，而正常、炎症或宫颈癌前病变归类为病理未升级组。使用多变量逻辑回归分析确定与升级相关的因素。
结果
在 511 例患者中，有 125 例（24.46%）患者病理升级。升级组患者年龄较小（47.68 ± 9.46 岁 vs. 52.11 ± 7.02 岁，P < 0.001），绝经患者比例较低（38.40% vs. 53.02%，P = 0.0111），高级别鳞状上皮内病变（HSIL）比例较低（40.00% vs. 57.77%，P = 0.001），HPV-16/18 阳性率较高（25.60% vs. 17.36%，P = 0.011），接触性出血率较高（54.40% vs. 21.50%，P < 0.001），高密度脂蛋白（HDL）水平较低（1.31 ± 0.29 mmol/L vs. 1.37 ± 0.34 mmol/L，P = 0.002），中性粒细胞计数较高（中位数，3.50 × 109/L vs. 3.10 × 109/L，P = 0.001），红细胞计数较高（4.01 ± 0.43 × 1012/L vs. 3.97 ± 0.47 × 1012/L，P = 0.002），血小板计数较高（204.84 ± 61.24 × 109/L vs. 187.06 ± 73.66 × 109/L，P = 0.012），血小板体积较小（中位数，11.50 fL vs. 11.90 fL，P = 0.002）。多变量逻辑回归分析显示，年龄（OR = 0.90，95%CI：0.86-0.94，P < 0.001）、绝经（OR = 2.68，95%CI：1.38-5.22，P = 0.004）、接触性出血（OR = 4.80，95%CI：2.91-7.91，P < 0.001）和平均血小板体积（OR = 0.83，95%CI：0.69-0.99，P = 0.038）与宫颈锥切术后 CIN3 升级为 CC 独立相关。
结论
年龄、绝经、接触性出血和平均血小板体积是宫颈锥切术后 CIN3 升级为 CC 的危险因素，有助于识别病理升级为 CC 的高风险和易感患者。
Zotero 插件