| Objectives:This article aims to retrospectively analyze the correlation between the pathological factors in the patients who have undergone conization and parametrial infiltration after secondary surgery in Qilu Hospital of Shandong University.Try to find relevant risk factors through statistical analysis.Then,try to stratify patients with early cervical cancer according to risk factors,and identify patients suitable for non-radical surgery.Methods:Retrospective analysis patients admitted to Qilu Hospital of Shandong University from July 2004 to July 2008.Inclusion criteria is patients who had a cervical conization（cold knife or LEEP）,and was followed by radical or modified radical hysterectomy.Collect general information of patients and pathological results of two operations,including:name,hospital number,age,maternal birth,conization,secondary surgery,staging,conization,secondary surgery,preoperative cervical cytology results,HPV test results,preoperative biopsy results,CT/MRI results,preoperative SCC-Ag levels,etc.The clinicopathological features of these cases were statistically described,and statistical methods were used to find high-risk factors affecting parametrial infiltration.Results:A total of 193 patients met the inclusion criteria,with an average age of 42.33±59.304 years,including 174 cases of squamous cell carcinoma,accounting for 90.2%,17 cases of adenocarcinoma,accounting for 8.3%,and 2 case ofadenosquamous carcinoma,accounting for 1.0%.112 cases（58.0%）were highly differentiated,53 cases（27.5%）were moderately differentiated,and 28 cases（14.5%）were poorly differentiated.1.Pathological results of conization:38.9%（83/193）patients had a positive margin after conization,and 30.6%（59/193）were positive for LVSI.The lesions diameter averaged 12.14±11.63 mm.If they were divided into 2 cm,174 patients（90.2%）had lesions≤2 cm,and 19 patients with lesion diameter>2 cm,accounting for 9.8%.The average invasion depth was 4.68± 2.94 mm.2.Secondary surgical pathology:A total of 8 cases of parametrial metastases were found,accounting for 4.1%of the total number of cases.A total of 11 cases were found to be positive for lymph nodes,accounting for 5.7%of the total cases.3.The results of single factor analysis indicated that LVSI was associated with infiltration of parametrial tissue in the cone-cut specimens（P<0.05）.In addition,lymph node metastasis（P=0.001）and preoperative SCC-Ag levels（P=0.023）were significantly associated with parametrial involvement,SCC-Ag>1.5 ng/ml（P= 0.011,OR=2.849）.Logistic binary regression multivariate analysis showed that lymph node positive（OR=92.491,95%CI:6.09-1405.11,P=0.001）and SCC-Ag level（OR=1.656,95%CI:1,09-2.50,P=0.017）were early Independent risk factors for cervical cancer PI4.For FIGO stage IA1-IA2 patients,there are no parametrial metastases.For IB1-IIA stage patients,lymph-vascular space invasion（p = 0.023）,lymph node metastasis（P<0.001）and were significantly associated with parametrial metastases.The degree of tumor differentiation（P=0.519）,conical margin（P=0.270）,and lesion diameter（P=0.636）were not statistically significant.4.For FIGO stage IB-IIA1 patients,if the lesion diameter is≤2cm,the invasion depth is≤10mm,the LVSI is negative,and the preoperative SCC-Ag≤1.5ng/ml,the parametrial metastases rate was 0%（0/105）,lymph node metastasis rate was 1%（1/105）.Conclusions:1.The incidence of parametrial metastases in early cervical cancer is very low.2.In early stage cervical cancer,FIGO stage,lymph node metastasis,preoperative SCC-Ag level and LVSI in conization specimens were significantly associated with infiltration of parametrial tissue.Lymph node positive and SCC-Ag levels were independent risk factors for early cervical cancer parametrial involvement.3.Conization specimens can be used as a preoperative evaluation method for stratification with low-risk patients.The parametrial infiltration rate of patients less than stage IA2 was 0%.Patients with stage IB1-IIA with lesion diameter≤2cm,infiltration depth:≤10mm,LVSI negative,preoperative SCC-Ag≤1.5ng/ml as low risk factors,and the incidence of parametrial infiltration was 0%.Patients with less than stage IA2 and IB1-IIA1 patients with low risk factors has potential beneficiary from non-radical surgery. |
