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Abstract：
BACKGROUND: To investigate related factors for postoperative pathological upgrading of cervical biopsy to cervical cancer (CC) in patients with cervical intraepithelial neoplasia (CIN)3 after conical resection.
METHODS: This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author\'s Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis.
RESULTS: Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86-0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38-5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91-7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69-0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection.
CONCLUSIONS: Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
METHODS: This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author\'s Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis.
RESULTS: Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86-0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38-5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91-7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69-0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection.
CONCLUSIONS: Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
摘要：
背景：探讨宫颈上皮内瘤变(CIN)3患者行锥形切除术后宫颈活检病理升级为宫颈癌(CC)的相关因素。
方法：本回顾性研究收集了2012年1月至2022年12月在作者医院进行宫颈活检诊断为CIN3的患者的数据。主要结果是锥形切除术后患者的病理结果。如果术后病理提示CC，则将病理结果分为病理升级组，而那些正常的，炎症，或宫颈癌前病变分为病理非升级组。使用多变量逻辑回归分析确定与升级相关的因素。
结果：在511名患者中，病理升级组125例(24.46%)。升级组患者较年轻（47.68±9.46vs.52.11±7.02,P<0.001),更年期女性的比例较低(38.40%vs.53.02%,P=0.0111),较低的HSIL比例(40.00%vs.57.77%,P=0.001),HPV-16/18阳性率较高（25.60%vs.17.36%,P=0.011),接触出血率较高(54.40%vs.21.50%,P<0.001)，较低的HDL水平（1.31±0.29vs.1.37±0.34mmol/L，P=0.002),较高的中性粒细胞计数(中位数，3.50vs.3.10×109/L,P=0.001),较高的红细胞计数（4.01±0.43vs.3.97±0.47×1012/L,P=0.002),更高的血小板计数（204.84±61.24vs.187.06±73.66×109/L,P=0.012),和较小的血小板体积（中位数，11.50vs.11.90fL,P=0.002)。多因素Logistic回归分析显示年龄(OR=0.90,95%CI:0.86～0.94,P<0.001),绝经（OR=2.68，95%CI：1.38-5.22，P=0.004），接触性出血(OR=4.80,95%CI:2.91-7.91,P<0.001),和平均血小板体积（OR=0.83，95％CI：0.69-0.99，P=0.038）与锥形切除术后从CIN3到CC的病理升级独立相关。
结论：年龄，更年期,接触出血,和平均血小板体积是锥形切除术后从CIN3到CC病理升级的危险因素，这可以帮助识别病理升级为CC的高风险和易感患者。
方法：本回顾性研究收集了2012年1月至2022年12月在作者医院进行宫颈活检诊断为CIN3的患者的数据。主要结果是锥形切除术后患者的病理结果。如果术后病理提示CC，则将病理结果分为病理升级组，而那些正常的，炎症，或宫颈癌前病变分为病理非升级组。使用多变量逻辑回归分析确定与升级相关的因素。
结果：在511名患者中，病理升级组125例(24.46%)。升级组患者较年轻（47.68±9.46vs.52.11±7.02,P<0.001),更年期女性的比例较低(38.40%vs.53.02%,P=0.0111),较低的HSIL比例(40.00%vs.57.77%,P=0.001),HPV-16/18阳性率较高（25.60%vs.17.36%,P=0.011),接触出血率较高(54.40%vs.21.50%,P<0.001)，较低的HDL水平（1.31±0.29vs.1.37±0.34mmol/L，P=0.002),较高的中性粒细胞计数(中位数，3.50vs.3.10×109/L,P=0.001),较高的红细胞计数（4.01±0.43vs.3.97±0.47×1012/L,P=0.002),更高的血小板计数（204.84±61.24vs.187.06±73.66×109/L,P=0.012),和较小的血小板体积（中位数，11.50vs.11.90fL,P=0.002)。多因素Logistic回归分析显示年龄(OR=0.90,95%CI:0.86～0.94,P<0.001),绝经（OR=2.68，95%CI：1.38-5.22，P=0.004），接触性出血(OR=4.80,95%CI:2.91-7.91,P<0.001),和平均血小板体积（OR=0.83，95％CI：0.69-0.99，P=0.038）与锥形切除术后从CIN3到CC的病理升级独立相关。
结论：年龄，更年期,接触出血,和平均血小板体积是锥形切除术后从CIN3到CC病理升级的危险因素，这可以帮助识别病理升级为CC的高风险和易感患者。
