Analysis Of Risk Factors And Construction Of Risk Prediction Model For Pathological Escalation After Cervical Conization In Patients With HSIL

Objective:Early invasive carcinoma of the cervix is occult and often needs to be diagnosed by cervical conization or hysterectomy.The purpose of this study is to explore the related factors of cervical high-grade intraepithelial lesions upgraded to cervical invasive cancer after conization,and to build a risk prediction model of cervical invasive cancer,so as to evaluate the risk of cervical early invasive cancer in patients with high-grade cervical lesions by biopsy,and to provide reference for the selection of appropriate surgical methods.Methods:A total of 593 patients who underwent cold knife conization from November 2019 to November 2020 in Qilu Hospital of Shandong University were collected and analyzed.The age,duration of lesion,menopause,contact bleeding,times of pregnancy and labor,HPV test results,TCT test results,SCC test results,colposcopy transformation area,colposcopy impression,ECC,biopsy pathological gland involvement and other related factors were analyzed by spss22.0 software.P<0.05 was taken as the difference was statistically significant.The factors with statistical significance were included in the binary logistic regression model for multivariate analysis.R studio was used to establish an individual prediction model for the risk of cervical invasive cancer,and a nomogram model was established.Bootstrap method was used to verify the model.Results:1.Among 593 patients,62(10.46%)were diagnosed as cervical invasive carcinoma by conization.2.Single factor chi square test showed that contact bleeding(X2=25.99,p<0.001),SCC test results(X2=5.278,p<0.05),high-risk HPV test results(X2=6.229,p<0.05),TCT test results(X2=23.691,p<0.001)and colposcopy impression(X2=22.808,p<0.001)were risk factors for detection of cervical invasive cancer.3.According to the multivariate logistic regression analysis,the regression model was established,and the AUC of the model was 0.79,the sensitivity was 80.6%,and the specificity was 65.3%.4.Build the nomogram model of cervical invasive cancer risk,and use bootstrap internal validation,the consistency index(c-index)is 0.790.Conclusion:In this study,the risk prediction model of cervical invasive cancer based on contact bleeding,SCC test results,TCT test results,colposcopy impression and HPV test results have a good fit,which can accurately predict the risk of cervical invasive cancer,and provide some reference for individual treatment.