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

Zhuoxin SHI; Hua LINGHU

doi:10.16016/j.1000-5404.201704085

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

Clinical Medicine | 更新时间：2026-01-09

- Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization
- Journal of Third Military Medical University Vol. 39, Issue 20, Pages: 2035-2041(2017)
- 作者机构：
  
  400046 重庆, 重庆医科大学附属第一医院妇产科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201704085
  CLC： R181.32;R730.56;R737.33
- Received：18 April 2017，
  
  Revised：2017-05-28，
  
  Published：30 October 2017
- 稿件说明：
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Zhuoxin SHI, Hua LINGHU. Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization[J]. Journal of Third Military Medical University, 2017, 39(20): 2035-2041.
DOI：

Zhuoxin SHI, Hua LINGHU. Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization[J]. Journal of Third Military Medical University, 2017, 39(20): 2035-2041. DOI： 10.16016/j.1000-5404.201704085.

摘要

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(

：7.094

95%

：1.350~37.279，

=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%

：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%

：0.492~0.886)。此外，高危HPV感染(

：8.674，95%

：1.047~ 71.862)、阴道分娩≥2次(

：10.708，95%

：1.543~74.322) 亦为复发危险因素(

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。

Abstract

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 (

: 7.094

95%

: 1.350~37.279

=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%

: 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%

0.492~0.886)

with sensitivity and specificity of 44.4% and 87.9%

respectively. Additionally

high risk HPV infection (

: 8.674

95%

: 1.047~71.862)

and vaginal delivery ≥2 times (

: 10.708

95%

: 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.

关键词

Keywords

references

FERLAY J, SOERJOMATARAM I, DIKSHIT R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5): E359-E386. DOI:10.1002/ijc.29210.

WRIGHT T C JR, COX J T, MASSAD L S, et al. 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia[J]. Am J Obstet Gynecol, 2003, 189(1):295-304.

ZHANG H, ZHANG T, YOU Z, et al. Positive surgical margin, HPV persistence, and expression of both TPX2 and PD-L1 are associated with persistence/recurrence of cervical intraepithelial neoplasia after cervical conization[J]. PLoS One, 2015, 10(12):e0142868. DOI:10.1371/journal.pone.0142868.eCollection 2015.

BOONSTRA H, OOSTERHUIS J W, OOSTERHUIS A M, et al. Cervical tissue shrinkage by formaldehyde fixation, paraffin wax embedding, section cutting and mounting[J]. Virchows Arch A Pathol Anat Histopathol, 1983, 402(2): 195-201. DOI:10.1007/bf00695061.

SOUTTER W P, SASIENI P, PANOSKALTSIS T. Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia[J]. Int J Cancer, 2006, 118(8): 2048-2055. DOI:10.1002/ijc.21604.

COSTA S, DE NUZZO M, INFANTE F E, et al. Disease persistence in patients with cervical intraepithelial neoplasia undergoing electrosurgical conization[J]. Gynecol Oncol, 2002, 85(1): 119-124. DOI:10.1006/gyno.2001.6579.

阮海波, 生启芳.不同锥切深度对LEEP治疗CIN疗效影响的临床研究[J].中国现代医生, 2015, 53(15): 27-30.

RUAN H B, SHENG Q F. Clinical studies of different depths of leep cone biopsy affect the efficacy of the treatment of cin[J]. China Modern Dr, 2015, 53(15): 27-30.

杨烨, 祝亚平.宫颈上皮内瘤变累腺深度与锥切范围的研究[J].现代妇产科进展, 2009, 18(4): 293-296.

YANG Y, ZHU Y P. A study of depth of cervical intraepitheliai neoplasia glandular involvement and the extent of cervical conization[J]. Prog Obstetr Gynecol, 2009, 18(4): 293-296.

贺豪杰, 潘凌亚, 黄惠芳, 等.宫颈锥切术对宫颈上皮内瘤变患者妊娠及其结局的影响[J].中华妇产科杂志, 2007, 42(8): 515-517. DOI:10.3760/j.issn:0529-567x.2007.08.003.

H J, PAN L Y, HUANG H F, et al. Clinical analysis of the effect of cervical conization on fertility and pregnancy outcome[J]. Chin J Obstetr Gynecol, 2007, 42(8): 515-517. DOI:10.3760/j.issn:0529-567x.2007.08.003.

吴瑾, 贾英, 唐良萏. LEEP术后宫颈上皮内瘤变复发病因分析[J].激光杂志, 2012, 33(2): 75-76. DOI:10.3969/j.issn.0253-2743.2012.02.033.

WU J, JIA Y, TANG L D. Retrospective analysis the reason of recurrences in cervical intraepithelial neoplasia after loop electrosurgical excision procedure[J]. Laser J, 2012, 33(2): 75-76. DOI:10.3969/j.issn.0253-2743.2012.02.033.

GÖK M, COUP V M, BERKHOF J, et al. HPV16 and increased risk of recurrence after treatment for CIN[J]. Gynecol Oncol, 2007, 104(2): 273-275. DOI:10.1016/j.ygyno.2006.10.011.

彭永排, 周晖, 卞丽娟, 等.高度宫颈上皮内瘤变电环切术后复发的预测因素[J].中山大学学报(医学科学版), 2012, 33(5): 619-624.

PENG Y P, ZHOU H, BIAN L J, et al. Predictors for recurrence of high-grade cervical intraepithelial neoplasia (cin) after loop electrosurgical excision procedure (leep)[J]. J Sun Yat-sen Univ (Med Sci), 2012, 33(5): 619-624.

KANG W D, KIM S M. Human papillomavirus genotyping as a reliable prognostic marker of recurrence after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia (CIN2-3) especially in postmenopausal women[J]. Menopause, 2016, 23(1): 81-86. DOI:10.1097/GME.0000000000000488.

SERATI M, SIESTO G, CAROLLO S, et al. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 165(1): 86-90. DOI:10.1016/j.ejogrb.2012.06.026.

PERISIC Z, PERISIC M, KARAPANDZIC V P, et al. Cervical conization-treatment for cervical intraepithelial neoplasia and carcinoma in situ [J ] . Eur J Gynaecol Oncol, 2011, 32(5): 534-537.

孙华盛. LEEP治疗宫颈上皮内瘤变256例疗效及其术后复发的影响因素分析[J].海南医学, 2013, 24(23): 3473-3475. DOI:10.3969/j.issn.1003-6350.2013.23.1444.

H S. Clinical effects of leep in the treatment of patients with cin and the influence factors of relapse[J]. Hainan Med J, 2013, 24(23): 3473-3475. DOI:10.3969/j.issn.1003-6350.2013.23.1444.

LIANG S N, HUANG Y J, LIU L L, et al. Study on the correlation between the expression of Ki67 and FasL and prognosis of cervical carcinoma[J]. Genet Mol Res, 2015, 14(3):8634-8639. DOI:10.4238/2015.july.31.11.DOI:10.4238/2015.

OMRAN O M, ALSHEEHA M. Human papilloma virus early proteins E6 (HPV16/18-E6) and the cell cycle marker P16 (INK4a) are useful prognostic markers in uterine cervical carcinomas in Qassim Region-Saudi Arabia[J]. Pathol Oncol Res, 2015, 21(1): 157-166. DOI:10.1007/s12253-014-9801-y.

ANSCHAU F, SCHMITT V M, LAMBERT A P, et al. Transition of cervical carcinoma in situ to invasive cancer: role of p16 INK4a expression in progression and in recurrenc e[J ] . Exp Mol Pathol, 2009, 86(1):46-50. DOI:10.1016/j.yexmp.2008.11.006.

YAMAZAKI T, TOMITA S, ICHIKAWA K, et al. P16-immunostaining pattern as a predictive marker of lymph node metastasis and recurrence in early uterine cervical cancer[J]. Pathobiology, 2006, 73(4): 176-182. DOI:10.1159/000096018.

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