Huang Guanxiang, Lin Wenyu, Gao Hangjing, Ren Yuan, Shen Jun, Xu Shuxia, Liu Dabin, Cai Yuanjun, Lin Chengbin, Lin Xite, Jiang Tingting, Dong Binhua, Sun Pengming
College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.
Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital (Fujian Women and Children's Hospital), Fuzhou, Fujian, 350001, People's Republic of China.
J Inflamm Res. 2024 Nov 19;17:9087-9102. doi: 10.2147/JIR.S494622. eCollection 2024.
There are currently few prognostic models for conization in patients with high-grade squamous intraepithelial lesion (HSIL) because it is a rapid procedure that typically collects less case information. The present study aimed to establish a rapid/accurate postoperative prognostic assessment model for these patients.
This study included 631 nonpregnant participants with HSIL confirmed by histopathology from January 2015 to January 2018. The recurrent/residual cervical intraepithelial neoplasia (CIN) were divided into residual CIN, simple recurrent CIN and recurrent CIN accompanied with CIN progression. The recurrence/residual-free survival (RFS) time was defined as the time span from the time of surgery (baseline) until the first lesion of CIN was detected or the 1-/3-/5-year follow-up endpoint was reached.
After LASSO regression selection, the higher platelet-to-lymphocyte ratio (PLR) (OR = 1.006, p = 0.002), positive margin status (OR = 2.451, p = 0.021), HPV-16 (OR = 4.414, p < 0.001), -18 (OR = 3.040, p = 0.009), -56 (OR = 10.715, p=0.021), and non-HR-HPV (OR = 2.487, p = 0.028) infection showed significant difference in the Logistic model. And HPV-16 infection (OR = 6.159, p = 0.001) could promote recurrent CIN accompanied with CIN progression. In multivariate Cox regression models, the higher PLR (HR = 1.005/1.005/1.005, p = 0.020/0.002/0.003) and HPV-16 infection (HR = 2.758/2.836/2.674, p < 0.001) showed statistical difference during 1-/3-/5-year follow-up. While gland invasion (p = 0.081), margin status (p = 0.075) and HPV infection genotype (p = 0.150) did not showed statistical difference in multivariate Cox regression models based on LASSO regression. And gland invasion (p = 0.251/0.686) and HPV-58 infection (p = 0.148/0.813) also showed no statistical difference in optimized Logistic regression models.
HPV-16, -18, -56 and non-HR-HPV infection status can be considered as indicators for recurrent CIN during the 5-year follow-up, especially for HPV-16 infection, which also lead to a CIN recurrence accompanied with disease progression. And the preoperative PLR level, gland invasion, positive margin may be predictors for recurrent/residual CIN during 1-, 3- and 5-year follow-up.
目前，针对高级别鳞状上皮内病变（HSIL）患者的锥切术，预后模型较少，因为该手术过程迅速，通常收集的病例信息较少。本研究旨在为这些患者建立一个快速/准确的术后预后评估模型。
本研究纳入了2015年1月至2018年1月间631例经组织病理学确诊的非妊娠HSIL患者。复发性/残留性宫颈上皮内瘤变（CIN）分为残留CIN、单纯复发性CIN和伴有CIN进展的复发性CIN。无复发/残留生存（RFS）时间定义为从手术时间（基线）到首次检测到CIN病变或达到1/3/5年随访终点的时间跨度。
经过LASSO回归筛选，较高的血小板与淋巴细胞比值（PLR）（OR = 1.006，p = 0.002）、切缘阳性状态（OR = 2.451，p = 0.021）、HPV-16（OR = 4.414，p < 0.001）、-18（OR = 3.040，p = 0.009）、-56（OR = 10.715，p = 0.021）和非HR-HPV（OR = 2.487，p = 0.028）感染在Logistic模型中显示出显著差异。并且HPV-16感染（OR = 6.159，p = 0.001）可促进伴有CIN进展的复发性CIN。在多因素Cox回归模型中，较高的PLR（HR = 1.005/1.005/1.005，p = 0.020/0.002/0.003）和HPV-16感染（HR = 2.758/2.836/2.674，p < 0.001）在1/3/5年随访期间显示出统计学差异。而腺体浸润（p = 0.081）、切缘状态（p = 0.075）和HPV感染基因型（p = 0.150）在基于LASSO回归的多因素Cox回归模型中未显示出统计学差异。并且腺体浸润（p = 0.251/0.686）和HPV-58感染（p = 0.148/0.813）在优化的Logistic回归模型中也未显示出统计学差异。
HPV-16、-18、-56和非HR-HPV感染状态可被视为5年随访期间复发性CIN的指标，尤其是HPV-16感染，其还会导致伴有疾病进展的CIN复发。并且术前PLR水平、腺体浸润、切缘阳性可能是1年、3年和5年随访期间复发性/残留性CIN的预测因素。
