CK7 Expression Of Cervical Squamocolumnar Junction In Postoperative Recurrence Of High-grade Cervical Lesions:role And Predictive Value

BackgroundCervical cancer is one of the most common gynecological malignancies.The increasing cases in China each year accounts for 1/4 around the world^[1].Cervical intraepithelial neoplasia（CIN）which reflect the continuous process of cervical cancer development is a closely related to invasive cervical cancer^[2].Although HPV vaccine can suppress women’s risk of cervical cancer,early detection and treatment of precancerous lesions without therapeutic vaccines or anti-HPV drugs is still the only way to avoid cervical cancer in women with HPV infection.Conization is the standard procedure for the treatment of cervical precancerous lesions currently.It has the dual functions of diagnosis and treatment.However,no matter how large the resection range is or the status of the resection margin,the risk of persistent or recurrent lesions always exists.Studies have shown that the recurrence rate of positive resection margins is about20%and the recurrence rate of negative resection margins is about 3%^[2].How to effectively reduce recurrence and how to deal with it is a difficult problem for clinicians.With the development of research,cervical SCJ cells have been paid more and more attention in the development of cervical cancer.Studies have shown that SCJ cells function as stem cells and are the main target cells for HPV infection.It is recognized as the tissue basis of most HSIL lesions.As one of the immunohistochemical markers of SCJ cells,CK7 has been paid much attention abroad.Recurrence after cone resection may be due to incomplete excision of SCJ cells.Some researchers have recently found that the use of an IHC marker for SCJ cells in LSIL biopsies can help predict the risk of progression to HSIL.LSIL with positive SCJ cell marker is more likely to progress to HSIL than LSIL with negative SCJ cell marker.Therefore,in this study,immunohistochemistry was used to detect the CK7 expression level of SCJ cells in each group,so as to explore the relationship between CK7 and postoperative recurrence of cervical cone resection,so as to provide a new direction for clinical prediction of postoperative recurrence of cone resection.ObjectiveTo Observe the relationship between CK7 expression and pathological grade and explore whether CK7 expression can predict the recurrence after cervical coning;To analyze the role of high-risk Human papilloma virus（hr-HPV）in the recurrence after cervical cone resection.MethodsFrom January 1,2016 to June 30,2019.06.30,a total of 17 cases of gynecological department of henan provincial people’s hospital underwent cervical coning resection（one or two times）due to HSIL or underwent multiple biopsy during the postoperative follow-up,and another 10 cases of patients with no lesions during the postoperative follow-up of cervical coning resection were selected as the control group.Specific inclusion criteria:all cases with biopsy,surgery and follow-up in our hospital;HSIL was confirmed by biopsy in each case.Exclusion criteria:cases where TCT suggested HSIL or LSIL;Secondary surgery was performed due to residual cervical coning.General clinical data,pathological data and follow-up screening data of all patients were collected,and specimens and biopsy specimens after cervical coning were collected.All pathological specimens were stained by CK7 immunohistochemistry with maxvisitm ready-to-use rapid immunohistochemistry one-step kit.Whether the expression of CK7 can predict the recurrence after cervical coning was analyzed by comparing the staining of CK7 between the recurrence group and the non-recurrence group.By analyzing the staining intensity of CK7 in different pathological grades,the relationship between pathological grade and CK7 staining intensity was discussed.To explore the role of hr-hpv in postoperative recurrence by analyzing hr-hpv infection during follow-up.Results1.There were 44 specimens in the three groups,including 23 HSIL lesions,16 LSIL lesions and 5inflammation;In HSIL and above cases,5 CK7 cases were positive,14 cases were strongly positive and 4cases were negative,6 cases were positive,3 cases were strongly positive and 7 cases were negative.Inflammation included 3 positive foci and 2 negative CK7.The expression of CK7 increased with the increase of pathological level（rs=0.843 by the three-point method）.2.The majority of recurrent specimens were LSIL10/17（58.82%）,followed by HSIL4/17（23.53%）and1 case of carcinoma in situ（5.88%）.Before and after recurrence,CK7 staining decreased 10/17（58.82%）,enhanced 4/17（23.53%）and remained unchanged 3/17（17.65%）.3.In the recurrence group,the types of HPV infection were HPV16,53,56,58,52,51,81,18,39,66,83,42 and 33,but HPV16 and 52 accounted for the majority of 11/17（64.71%）.In the group without recurrence,HPV types were HPV81,68,51,52,18,56 and 39,among which HPV51 accounted for7/10（70%）.Conclusions1.CK7 as an immune marker of SCJ,plays a certain role in the development of cervical lesions;2.The expression intensity of cervical epithelial CK7 increased with the increase of pathological level;3.The pathological types of recurrence after cervical tapering were LSIL;4.Hr-hpv,especially HPV16 and 52,are the risk factors for recurrence after conical resection.