■宫颈上皮内瘤变(CIN)是与宫颈浸润性癌相关的癌前病变的统称。治疗选择取决于疾病的发展和进展。特别是对于年龄在25岁及以上且有生育要求的CINII级患者,确定进行保守治疗还是切除治疗是一项临床挑战.切除治疗会增加过度治疗结果的风险,如宫颈机能不全,早产,流产,胎膜早破,在有生育潜力的年轻女性中。P16免疫组织化学染色大大提高了CINII患者诊断的一致性。这项研究的目的是分析预测宫颈上皮内瘤变II级P16阳性患者25岁以上宫颈切除术后病理退化的危险因素,并提供信息以帮助优化CINII疾病患者的临床治疗。
■单因素和logistic回归模型分析CINII/P16阳性(+)组病理分级降低的危险因素。根据logistic回归模型计算CINII/P16(+)组患者病理降级的预测概率,生成新的受试者工作特征(ROC)曲线的变量多指标关联,以确定预测能力。
■共纳入248名符合纳入和排除标准的女性。统计学分析表明,冷刀锥切术(CKC)后,CINII/P16()组的病理降级率高于CINIII组(χ2=6.26,P=0.012)。单因素表明,比较年龄差异有统计学意义,涉及活检的象限数量,更年期状态,和腺体的参与,分别为(P<0.05)。相比之下,比较细胞学结果时,差异无统计学意义,转换区的类型,高危型人乳头瘤病毒(HR-HPV)检测,流产状况,怀孕频率,两组之间从诊断到CKC的时间和Ki67百分比。多因素logistic回归显示,活检NII受累程度[优势比(OR),1.589],绝经状态(或,4.031),和腺体受累(或,5.549)是CINII/P16()患者组病理降级的独立危险因素(P<0.05)。ROC曲线下面积(AUC)的显著性顺序如下:联合多个指标(AUC0.716)>腺体受累(AUC0.625)>活检NII受累程度(AUC0.614)>绝经状态(AUC0.565)。
■在年龄超过25岁的CINII/P16阳性患者中,CKC后病理降级率较高。诊断为CINII/P16阳性的患者存在过度治疗。病理降级的独立因素由这些因素确定,包括病变是否累及腺体,CINII受累于活检的程度,和更年期状态。
UNASSIGNED: Cervical intraepithelial neoplasia (CIN) is a collective term for pre-cancerous lesions associated with cervical invasive carcinoma. Treatment options depend on the development and progression of the disease. Especially for patients with CINII grade who are aged 25 years and older and have fertility requirements, it is a clinical challenge to determine whether to proceed with conservative or excisional treatment. Excisional treatment increases the risk of
overtreatment outcomes, such as cervical insufficiency, preterm labor, miscarriage, and premature rupture of membranes, in young women with childbearing potential. P16 immunohistochemical staining has greatly improved the consistency of CINII patient\'s diagnosis. The aim of this study was to analyze the risk factors predicting pathological degradation after cervical excision in cervical intraepithelial neoplasia grade II P16-positive patients over 25 years old, and to provide information to help optimize clinical treatments patients with CINII disease.
UNASSIGNED: Single-factor and logistic regression models were used to analyze the risk factors for pathological downgrading in the CINII/P16-positive (+) group. The predicted probability of pathological downgrading in the CINII/P16(+) group of patients was calculated according to the logistic regression model to generate a new variable multi-indicator association for receiver operating characteristic (ROC) curve plotting to determine the predictive ability.
UNASSIGNED: A total of 248 women who met the inclusion and exclusion criteria were included. Statistical analysis showed that the CINII/P16(+) group had a higher pathological downgrading rate compared with the CINIII group after cold knife conization (CKC) (χ2=6.26, P=0.012). Univariate factors showed that the differences were statistically significant when comparing age, number of biopsy-involved quadrants, menopausal status, and involvement of glands, respectively (P<0.05). In contrast, the differences were not statistically significant when comparing cytological findings, type of transformation zone, high-risk human papilloma virus (HR-HPV) testing, abortion status, pregnancy frequency, time from diagnosis to CKC and Ki67 percentage between the two groups. Multifactorial logistic regression showed that the extent of biopsy CINII involvement [odds ratio (OR), 1.589], menopausal status (OR, 4.031), and glandular involvement (OR, 5.549) were all independent risk factors for pathological downgrading in the CINII/P16(+) patient group (P<0.05). The order of significance of the areas under the ROC curve (AUCs) was as follows: combined multiple indicators (AUC 0.716) > gland involvement (AUC 0.625) > biopsy CINII involvement extent (AUC 0.614) > menopausal status (AUC 0.565).
UNASSIGNED: A higher rate of pathological downgrading after CKC was found in CINII/P16-positive patients who were aged over 25 years.
Overtreatment exists in patients with CINII/P16-positive diagnosis. Independent factors for pathological downgrading were identified by the factors including if the lesion involved the gland, the extent of CINII involvement on biopsy, and menopausal status.