The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization

Abstract

The aim of this study was to illuminate risks factors of residual lesions, and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive margin who underwent cervical conization.A retrospective cohort study of 218 patients with positive margin after conization, including cold knife conization (CKC) and loop electrosurgical excisional procedure (LEEP), and follow-up from 2013 through 2016. The diagnosis of residual disease and recurrence were established and confirmed by biopsy. We evaluate the correlations among residual rate, recurrence rate, and clinical parameters, such as age, menopausal status, gravity, parity, glandular involvement, thinprep cytologic test (TCT), and human papillomavirus (HPV) results. We also detect the difference between CKC and LEEP.There was statistical difference between the positive margin rate of CKC group and LEEP regarding the surgery methods (5.8% and 12.09% separately, P < .001). Residual disease was found in 53.66% cases where 41 patients received second surgery after conization. Besides, age (P = .027), menopausal status (P = .006), and HPV infection (P = 0.018) were significantly associated with residual lesion. Among 177 cases with histopathologic follow-up, 15.91% women relapsed from 4 to 27 months. As for recurrence we found it was more frequent with HPV infection and glandular involvement (P < .001). TCT was also an independent factor in patients with recurrence of lesion. No evidence shows difference between CKC and LEEP for recurrence rate (P = .918).The factors related to rate of residual lesion were age, menopausal status, and HPV infection. HPV infection, TCT, and glandular involvement were associated with HSIL recurrence. LEEP was as effective as CKC with regard to recurrence rate. Further large-scale studies are needed to confirm our findings.

Establishment of Multifactor Predictive Models for the Occurrence and Progression of Cervical Intraepithelial Neoplasia

“…In this study, the proportion of premenopausal cases of CIN was signi cantly higher than that of SCC cases, and logistic analysis found that premenopause was one of the independent risk factors for the progression of CIN. Chen et al [18] studied patients with CIN who relapsed after receiving cervical conization or LEEP treatment, and the reoccurrence rate of premenopausal patients was signi cantly higher than that of menopausal patients, which is consistent with this study. However, Renata B et al [19] reported that postmenopausal CIN patients were more prone to interstitial in ltration and progression to invasive cervical cancer.…”

Establishment of multifactor predictive models for the occurrence and progression of cervical intraepithelial neoplasia

“…In this study, the proportion of premenopausal cases of CIN was significantly higher than that of SCC cases, and logistic analysis found that premenopause was one of the independent risk factors for the progression of CIN. Chen et al [18] studied patients with CIN who relapsed after receiving cervical conization or LEEP treatment, and the reoccurrence rate of premenopausal patients was significantly higher than that of menopausal patients, which is consistent with this study. However, Renata B et al [19] reported that postmenopausal CIN patients were more prone to interstitial infiltration and progression to invasive cervical cancer.…”

Evaluation of Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence

“…Preinvasive cervical lesion is limited to epithelial and if left untreated, may progress to advanced form of cervical cancer (Garcia et al, 2012). The incidence of cervical cancer as one of the most common gynecological cancers has been increasing in recent decades and cervical intra-epithelial neoplasia (CIN) is known as one of the precursors to cervical cancer (Chen et al, 2018). Generally, CIN is divided into (i) CIN I which is equivalent to mild dysplasia, (ii) CIN II which is equivalent to moderate dysplasia, and (iii) CIN III which is equivalent to severe dysplasia or in-situ carcinoma (Rock and Jones, 2016).…”