Yao Xiaoxi, Qie Mingrong, Kang Leni, Li Mengyao, Liu Qingyu, Liang Xiao, Liao Guangdong
Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China.
BMC Cancer. 2025 Jul 29;25(1):1238. doi: 10.1186/s12885-025-14565-3.
To identify risk factors for a final diagnosis of cervical cancer in patients initially diagnosed with high-grade cervical intraepithelial neoplasia and to evaluate a combined Cytology-Endocervical Curettage (ECC) index for predicting cancer risk.
This retrospective study included 11,651 patients at West China Second University Hospital (WCSUH) with biopsy-confirmed high-grade cervical intraepithelial neoplasia over a five-year period. Patients were divided into two groups based on whether they ultimately received a diagnosis of cervical cancer following surgery. Multivariate logistic regression was used to identify independent risk factors, and receiver operating characteristic (ROC) curves were constructed to assess the performance of the Cytology-ECC index.
Of the 11,651 patients, 229 were subsequently diagnosed with cervical cancer. Multivariate analysis identified age (OR = 1.10, 95% CI: 1.06-1.14), abnormal vaginal bleeding (OR = 2.94, 95% CI: 1.75-4.92), human papillomavirus (HPV)16/18 infection (OR = 2.56, 95% CI: 1.62-4.03), single HPV type infection (OR = 1.68, 95% CI: 1.03-2.75), atypical squamous cells, cannot exclude HSIL (ASC-H) (OR = 3.77, 95% CI: 1.68-8.45), high-grade squamous intraepithelial lesion (HSIL) (OR = 4.65, 95% CI: 2.16-10.05), and endocervical glandular involvement (OR = 1.59, 95% CI: 1.01-2.49) as independent risk factors (all P < 0.05). The Cytology-ECC index demonstrated a predictive accuracy with an area under the curve (AUC) of 0.787, outperforming cytology or ECC alone.
Age, abnormal vaginal bleeding, HPV16/18, single HPV type infection, ASC-H, HSIL, and endocervical glandular involvement were independent predictors of cervical cancer in patients with an initial biopsy of high-grade cervical intraepithelial neoplasia. The combined Cytology-ECC index showed enhanced predictive value in clinical decision-making and may aid in earlier identification of patients at elevated risk for undetected invasive disease.
确定最初诊断为高级别宫颈上皮内瘤变的患者最终诊断为宫颈癌的危险因素，并评估细胞学-宫颈管刮术（ECC）联合指数对癌症风险的预测能力。
这项回顾性研究纳入了在五年期间于华西第二医院（WCSUH）经活检确诊为高级别宫颈上皮内瘤变的11651例患者。根据患者术后是否最终被诊断为宫颈癌将其分为两组。采用多因素逻辑回归分析确定独立危险因素，并构建受试者工作特征（ROC）曲线以评估细胞学-ECC指数的性能。
在11651例患者中，229例随后被诊断为宫颈癌。多因素分析确定年龄（OR = 1.10，95%CI：1.06-1.14）、异常阴道出血（OR = 2.94，95%CI：1.75-4.92）、人乳头瘤病毒（HPV）16/18感染（OR = 2.56，95%CI：1.62-4.03）、单一HPV型别感染（OR = 1.68，95%CI：1.03-2.75）、非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H）（OR = 3.77，95%CI：1.68-8.45）、高级别鳞状上皮内病变（HSIL）（OR = 4.65，95%CI：2.16-10.05）以及宫颈管腺体受累（OR = 1.59，95%CI：1.01-2.49）为独立危险因素（均P < 0.05）。细胞学-ECC指数的曲线下面积（AUC）为0.787，显示出预测准确性，优于单独的细胞学或ECC。
年龄、异常阴道出血、HPV16/18、单一HPV型别感染、ASC-H HSIL和宫颈管腺体受累是最初活检为高级别宫颈上皮内瘤变患者宫颈癌的独立预测因素。细胞学-ECC联合指数在临床决策中显示出更高的预测价值，可能有助于更早识别未被发现的浸润性疾病风险升高的患者。
