Risk Factors Predicting Recurrence In Patients With Negative Margin After Conization For High Grade Cervical Intraepithelial Squamous Lesion

Objective: To retrospectively analyze recurrent cases of negative resection margins after high-grade squamous intraepithelial lesions of the cervix to understand the relevant risk factors that affect the recurrence of the disease,and to provide a basis for the follow-up treatment and follow-up strategies of such patients.Methods: Forty-two patients who were treated in the Second Hospital of Hebei Medical University from January 2010 to December 2017,confirmed to have high-grade squamous intraepithelial lesions of the cervix by pathology and performed a LEEP or cold knife cone dissection were selected for retrospective analysis.A 1: 2 matched case-control study was used to analyze the relationship between age,menopausal status,parity,cervical cytology results before the first conization,HPV infection type,lesion range,cone resection method,whether the lesion was glandular and recurrence of patients with negative resection margin after cervical cone resection.Results: From January 2010 to December 2017,a total of 3231 patients met the above conditions,of which 42 patients are recurrent during follow-up.The shortest recurrence interval after the first conization was 3 months after surgery.19.1% relapsed within 1 year after operation,and 80.9% occurred within 1-2 years after operation.The comparison of general data was made by chi-square test,and the results showed: There was a significant difference between the recurrence group and the control group in the distribution of the age(χ2 = 4.791,P = 0.014),menopause status(χ2 = 4.095,P = 0.025),preoperative TCT(χ2 = 4.169,P = 0.019),lesion range(χ2 = 2.333,P = 0.048)and recurrent gland(χ2 = 3.326,P = 0.030).Univariate Logistic regression analysis showed that age ≥40 years(P = 0.931,OR = 2.442)and preoperative TCT ≥HSIL(P = 0.043,OR = 2.179)were associated with recurrence after conization.Multivariate Logistic regression analysis showed that age ≥40 years(P = 0.028,OR = 2.518,95% CI 1.103,5.751)and preoperative TCT ≥ HSIL(P = 0.039,OR = 2.250,95% CI 1.040,4.869)were independent risk factors for recurrence of the disease after conization.Conclusions: 1.The rate of recurrence of cervical high-grade squamous intraepithelial lesions in patients with negative resection margins is 1.3% within two years,19.1% of patients with relapses occur within 1 year,and 80.9% occur within 1-2 years after surgery.It suggests that the importance of our close follow-up after surgery.2.Age ≥ 40 years and preoperative cytology ≥ HSIL are independent risk factors for recurrence of patients with negative margins after conization.Patients with one risk factor should be followed up intensively,and patients with two risk factors should be more closely followed.Value.Menopausal status,extent of lesions,glandular involvement,parity of pregnancy,HPV infection type,and conization type were not related to recurrence.