Outcome And Related Factors Of LEEP Treatment In Postmenopausal Women With Cervical HSIL

Objective Retrospective study the therapeutic effect of Loop Electrosurgical Excision Procedure(LEEP)in postmenopausal women with High-grade Squamous Intraepithelial Lesions(HSIL),and to explore the related factors affecting the therapeutic effect,providing these patients with more clinical experiences for treatment choice.Methods The postmenopausal women diagnosed with HSIL by the colposcopy of the First Affiliated Hospital of Gannan Medical University,from January 2017 to December 2018,according with the inclusion and exclusion criteria,received LEEP surgery.All patients’ cervical tissues after LEEP were sent for routine pathological examination,and cervical fluid-based cytology(TCT),colposcopy,and high-risk HPV were reviewed 6 months after surgery.Collect and record the clinical data of patients through follow-up and electronic medical record system,such as name,age,education,menstrual status,history of vaginal delivery,TCT results before and after surgery,HPV status before surgery,6 months HPV status after surgery,sufficiency of colposcopy,type of transformation zone,number of colposcopy biopsy,diameter of affected area of the lesion,condition of surgical margins,involvement of the gland,etc.Statistical analyses were applied in postoperative HPV outcomes and related factors of HPV persistence,postoperative pathological outcomes and related factors,rate of positive margin and related risk factors,and cure rate of LEEP in postmenopausal women with HSIL.Results 1.There were 423 women diagnosed with HSIL who underwent cervical LEEP,and 118 patients met the inclusion and exclusion criteria.The age range was 48 to 77 years,with a median of 53 years and an average age of 54.10 years.Menopausal time is 1 to 26 years,with an average menopausal time of5.27 ± 4.62 years.2.The overall negative HPV rate after LEEP was 76.62%.Chi-square test showed no statistical difference in comparison of negative HPV rate of various types,P = 0.493.Univariate and multivariate logistic regression analysis showed that the postoperative TCT(NILM)and the diameter of the affected area(≤1cm)were independent related factors for HPV to negative(P<0.05).The TCT results with high lesions or the larger cervical area lesions(>1cm)were independent risk factors for persistent HPV after surgery.3.The pathological coincidence rate after LEEP was 61.01%,the pathological escalation rate and degradation rate were7.63% and 31.35%,respectively,and the chi-square test showed P= 4.5E-5,which had significant statistical significance.Univariate and multivariate logistic regression analysis showed that lesions involving glands,preoperative TCT(HSIL),and positive margins were independent negatively related factors of pathological degradation.The number of vaginal births(≤ 2)and lesions involving glands were independently related factors for pathologically coincidence.4.The negative margin rate after LEEP was 70.64%,and the positive margin rate was 29.36%,excluding 9patients with pathologically upgraded cervical cancer.Chi-square test compared the margin positive rate and negative rate,P=1.09E-09 with significant statistical difference.Univariate and multivariate logistic regression analysis showed that the involvement of the glands in the lesions was an independent risk factor for positive margins.5.There were 62 patients both negative pathologic margins and negative HPV after LEEP,the cure rate was 56.88%.Conclusions LEEP surgery can achieve good HPV negative conversion rate and cure rate in postmenopausal patients with HSIL.