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Abstract：
OBJECTIVE: To identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL.
METHODS: The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading.
RESULTS: 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2-59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244-12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78-23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947-14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892-11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good.
CONCLUSIONS: There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.
METHODS: The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading.
RESULTS: 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2-59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244-12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78-23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947-14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892-11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good.
CONCLUSIONS: There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.
摘要：
目的：探讨宫颈高级别鳞状上皮内病变（HSIL）合并隐匿性宫颈癌的危险因素，规范HSIL初治管理。
方法：收集2018-2023年2家三级医院和3家二级医院妇产科因HSIL直接行子宫全切除术患者的临床资料。它们的一般特征，分析病理参数和生存状态。采用Logistic回归模型分析临床参数与术后病理升级的相关性。
结果：1.在314例直接行子宫全切除术的HSIL患者中,73.2%来自基层医院。2.25例患者（7.9％）病理升级为宫颈癌，所有这些都是早期浸润性癌症。3.到目前为止,25例早期浸润性癌患者没有复发或死亡，中位随访期为21个月（2-59个月）。4.腺体受累（OR3.968;95CI1.244-12.662）和病变范围≥3个象限（OR6.527;95%CI1.78-23.931），HPV16/18感染（OR5.382;95CI1.947-14.872），TCT≥ASC-H(OR4.719;95CI1.892-11.766)是影响术后病理升级的独立危险因素。5.Logistic回归模型计算的曲线下面积(AUC)为0.840,说明预测值较好。
结论：HSIL患者存在隐匿性宫颈癌的风险。腺体参与，病变范围≥3个象限,HPV16/18感染和TCT≥ASC-H是HSIL合并隐匿性宫颈癌的独立危险因素。活检证实的HSIL患者接受筋膜外子宫切除术和意外的早期浸润性癌的预后可能很好。
方法：收集2018-2023年2家三级医院和3家二级医院妇产科因HSIL直接行子宫全切除术患者的临床资料。它们的一般特征，分析病理参数和生存状态。采用Logistic回归模型分析临床参数与术后病理升级的相关性。
结果：1.在314例直接行子宫全切除术的HSIL患者中,73.2%来自基层医院。2.25例患者（7.9％）病理升级为宫颈癌，所有这些都是早期浸润性癌症。3.到目前为止,25例早期浸润性癌患者没有复发或死亡，中位随访期为21个月（2-59个月）。4.腺体受累（OR3.968;95CI1.244-12.662）和病变范围≥3个象限（OR6.527;95%CI1.78-23.931），HPV16/18感染（OR5.382;95CI1.947-14.872），TCT≥ASC-H(OR4.719;95CI1.892-11.766)是影响术后病理升级的独立危险因素。5.Logistic回归模型计算的曲线下面积(AUC)为0.840,说明预测值较好。
结论：HSIL患者存在隐匿性宫颈癌的风险。腺体参与，病变范围≥3个象限,HPV16/18感染和TCT≥ASC-H是HSIL合并隐匿性宫颈癌的独立危险因素。活检证实的HSIL患者接受筋膜外子宫切除术和意外的早期浸润性癌的预后可能很好。
