Higami Shota, Tanaka Yusuke, Deguchi Tomomi, Shiraishi Mariko, Shiki Yasuhiko
Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan.
Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan.
Mol Clin Oncol. 2024 Sep 9;21(5):84. doi: 10.3892/mco.2024.2782. eCollection 2024 Nov.
The present study aimed to investigate the surgical, oncological and obstetric outcomes of the Shimodaira-Taniguchi (S-T) conization method. A total of 858 cases of high-grade intraepithelial lesions treated with S-T conization were retrospectively reviewed, and the surgical, oncological and obstetric outcomes were analyzed. The χ test was used to compare the clinical characteristics between patients with and without cervical stenosis. The factors associated with recurrent/persistent disease were analyzed using univariate and multivariate analyses with a Cox hazards regression model. The obstetric outcomes after conization were also evaluated. Cervical stenosis and recurrent/persistent disease occurred in 2.2 and 4.9% of the patients, respectively. Older age [≥45 years; hazard ratio (HR), 3.22; 95% CI, 1.73-6.02] and surgical margin involvement (HR, 6.39; 95% CI, 3.44-11.8) were independently associated with recurrent/persistent disease. In particular, older patients with endocervical margin involvement showed a higher rate of recurrence (3-year recurrence rate, 28.1%). The proportion of patients who experienced cervical stenosis was significantly higher in older patients (0.95 vs. 5.7%; P<0.001). Among the 66 deliveries after conization, term delivery was observed in 62 cases (93.9%). The proportion of patients who experienced preterm delivery after conization was significantly higher in patients with a short interval from conization to conception (P=0.045). In conclusion, the S-T conization method was effective in terms of surgical, oncological and obstetric outcomes. A careful follow-up is required for older patients with positive surgical margins, particularly those with positive endocervical margins. In addition, a short interval of ≤3 months from conization to conception should be avoided to expect term pregnancy.
本研究旨在探讨下平田-谷口（S-T）锥形切除术的手术、肿瘤学及产科结局。回顾性分析了858例行S-T锥形切除术治疗的高级别上皮内病变病例，并分析其手术、肿瘤学及产科结局。采用χ检验比较有和没有宫颈狭窄患者的临床特征。使用Cox风险回归模型进行单因素和多因素分析，以分析与复发/持续性疾病相关的因素。还评估了锥形切除术后的产科结局。宫颈狭窄和复发/持续性疾病分别发生在2.2%和4.9%的患者中。年龄较大[≥45岁；风险比（HR），3.22；95%置信区间（CI），1.73 - 6.02]和手术切缘受累（HR，6.39；95%CI，3.44 - 11.8）与复发/持续性疾病独立相关。特别是，宫颈管切缘受累的老年患者复发率更高（3年复发率，28.1%）。老年患者发生宫颈狭窄的比例显著更高（0.95%对5.7%；P<0.001）。在锥形切除术后的66例分娩中，62例（93.9%）为足月分娩。锥形切除术后至受孕间隔时间短的患者发生早产的比例显著更高（P = 0.045）。总之，S-T锥形切除术在手术、肿瘤学及产科结局方面是有效的。对于手术切缘阳性的老年患者，尤其是宫颈管切缘阳性的患者，需要进行仔细的随访。此外，应避免锥形切除术后至受孕间隔时间≤3个月，以期望足月妊娠。
