锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响

目的 探索高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)术后复发/持续危险因素,以指导确定锥切范围及制定术后随访计划.方法 回顾性分析2013年8月至2016年6月于我院妇科病房行锥切治疗并诊断为高级别宫颈上皮内瘤变的113例,分析其临床病理特征与术后复发的关系.随访时间2～39个月,中位随访时间19个月.结果 113例患者中有9例复发,多因素分析提示标本厚度(锥切宽度)与术后复发密切相关(HR:7.094,95％ CI:1.350 ～ 37.279,P=0.021).手术中锥切宽度小于1.77 cm时,其预测术后复发灵敏度为88.9％,特异度为83.8％,曲线下面积(AUC)为0.81(95％ CI:0.650 ～0.971);锥切深度小于2.24 cm时,预测复发灵敏度为44.4％,特异度为87.9％,曲线下面积(AUC)为0.689(95％ CI:0.492～0.886).此外,高危HPV感染(HR:8.674,95％ CI:1.047 ～71.862)、阴道分娩≥2次(HR:10.708,95％ CI:1.543～74.322)亦为复发危险因素(P＜0.05).结论 锥切范围不够是高级别宫颈上皮内瘤变的复发高危因素,建议尽可能行深宽锥切,对合并高危HPV感染、多次阴道分娩、锥切宽度小于1.77 cm、锥切深度小于2.24 cm者,术后需联合宫颈细胞学、HPV基因分型和阴道镜密切随访.

Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization

Objective To investigate the risk factors for persistence or recurrence of high-grade cervical intraepithelial neoplasia (CIN) after conization in order to guide cone size and postoperative follow-up plan.Methods Clinical data of 113 patients who received cervical conization for hgCIN in our department between August 2013 and June 2016 were collected and reviewed retrospectively.The correlation of clinicopathological parameters and postoperative recurrence was analyzed.The median follow-up time was 19 months (ranging from 2 to 39 months).Results Recurrence occurred in 9 patients during the follow-up period.Multivariate analysis showed specimen thickness (cone width) was closely associated with CIN recurrence (HR:7.094,95％CI:1.350～37.279,P=0.021).When the cone width less than 1.77 cm,the area under the receiver operating characteristic (ROC) curve (AUC) was 0.81 (95％ CI:0.650 ～0.971),with sensitivity and specificity of 88.9％ and 83.8％,respectively.When the cone depth less than 2.24 cm,the AUC of ROC curve was 0.689 (95％ CI:0.492 ～0.886),with sensitivity and specificity of 44.4％ and 87.9％,respectively.Additionally,high risk HPV infection (HR:8.674,95％ CI:1.047 ～71.862),and vaginal delivery ≥2 times (HR:10.708,95％ CI:1.543～74.322) were predictive factors for CIN recurrence.Conclusion Cone size not wide or deep enough is an innegligible high risk factor for recurrence of high-grade CIN after cervical conization,so wider and deeper conization is suggested.For those with high risk HPV infection,multiple vaginal delivery,small conization (cone width ＜ 1.77 cm,cone depth ＜2.24 cm),close follow-up is recommended,including cervical cytology,HPV genotyping and colposcopy.