Clinicopathological analysis of 165 cases of total hysterectomy with cervical HSIL
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摘要:
目的 探讨宫颈高度鳞状上皮内病变(high-grade squamous intraepithelial lesion，HSIL)初始治疗行全子宫切除病理升级浸润癌的相关危险因素及病理特点。 方法 回顾性分析2010年1月—2020年1月蚌埠医学院第一附属医院诊断为HSIL，初始治疗行全子宫切除的165例患者，根据绝经年限分为未绝经组(52例)与绝经组(113例)，根据病理分为浸润组(26例)与未浸润组(139例)，研究影响病理升级的相关危险因素及病理特点。 结果 165例HSIL中浸润癌26例，总发生率(26/165，15.8%)。未绝经组病理升级率(6/52, 11.5%)与绝经组病理升级率(20/113，17.7%)，比较差异无统计学意义(χ2=0.756，P=0.385)；未绝经组单因素分析：病变点数≥3点、病变累腺、行人工流产≥2次为病理升级的危险因素。logistic回归分析结果显示病变点数≥3点及病变累腺为病理升级的独立危险因素；绝经组单因素分析：病变点数≥3点、病变累腺、绝经年限≥5年为病理升级的危险因素。logistic回归分析显示这3个因素同样也是病理升级的独立危险因素；未绝经组浸润癌6例，4例ⅠA1期；2例ⅠA2期中1例淋巴脉管浸润；绝经组的20例，16例ⅠA1期，其中有1例出现淋巴脉管浸润，4例ⅠA2期。 结论 绝经与否在HSIL患者中直接采用全宫切除对病理升级差异无统计学意义；对于HSIL患者，不论是否绝经，病变点数≥3点及病变累腺都需要警惕浸润癌的发生；绝经年限≥5年者病理升级率会升高；HSIL患者行全宫切除后病理升级患者均为早期浸润癌。 -
关键词:
- 宫颈高度鳞状上皮内病变 /
- 全子宫切除 /
- 宫颈浸润癌 /
- 危险因素
Abstract:Objective To investigate the related risk factors and pathological characteristics of pathologically upgraded invasive carcinoma after total hysterectomy in the initial treatment of cervical high-grade squamous intraepithelial lesion (HSIL). Methods Retrospective analysis was performed on 165 patients who received total hysterectomy as initial treatment for HSIL in the First Affiliated Hospital of Bengbu Medical College from January 2010 to January 2020. They were divided into premenopausal group (52 cases) and menopausal group (113 cases). According to pathology, they were divided into infiltrating group and non-infiltrating group. The related risk factors and pathological characteristics of pathological progression were studied. Results Among the 165 HSIL cases, 26 cases had invasive cancer, with a total incidence of (15.8%, 26/165). The pathological upgrading rate of the premenopausal group was 11.5% (6/52). The pathological upgrading rate of the menopausal group was 17.7% (20/113). Univariate analysis in premenopausal group: lesion number ≥ 3 points, lesion gland accumulation and abortion ≥ 2 times were the risk factors of pathological upgrading. Logistic regression analysis showed that lesion number ≥ 3 points and lesion gland accumulation were the independent risk factors of pathological upgrading. Univariate analysis in menopausal group: the number of lesions ≥ 3 points, gland accumulation and menopausal years ≥ 5 years were the risk factors of pathological upgrading. Logistic regression analysis showed that these three points were also the independent risk factors of pathological upgrading. Six cases of invasive cancer in premenopausal group, 4 cases of ⅠA1 stage, 2 cases of lymphatic vascular infiltration in ⅠA2 stage. Among the 20 patients in the menopausal group, 16 patients had stage ⅠA1, including 1 patient with lymphatic vascular infiltration and 4 patients with stage ⅠA2. Conclusion There is no significant difference in pathological upgrading between menopausal and premenopausal patients. For patients with HSIL, regardless of menopause or not, the number of lesions ≥ 3 and the number of lesion glands should be vigilant against the occurrence of invasive cancer. The pathological upgrading rate will increase in patients with menopausal years>5 years. The pathology of HSIL patients after total hysterectomy was all early invasive carcinoma. -
表 1 影响未绝经女性HSIL全子宫切除术后升级为宫颈癌的单因素分析
(例) 组别 例数 接触性出血 病变点数(点) 病变累及腺体 产次(次) 流产次数(次) 是否行宫颈管搔刮 HPV高危型感染 (+) (-) ≥3 < 3 是 否 ≥2 < 2 ≥2 < 2 是 否 有 无 浸润组 6 3 3 4 2 1 5 5 1 3 3 0 6 5 1 未浸润组 46 19 27 6 40 35 11 38 8 40 6 11 35 39 7 χ2值 0.001 9.826 8.798 0.002 5.065 1.820 0.009 P值 0.973 0.001 0.003 0.965 0.024 0.177 0.926 
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表 2 影响未绝经女性HSIL全子宫切除术后升级为宫颈癌的多因素分析
变量 B SE Wald χ2 P值 OR值 95%CI 病变点数 2.503 1.235 4.110 0.043 12.216 1.087~137.341 流产次数 2.371 1.306 3.298 0.069 10.712 1.829~138.501 病变是否累腺 2.907 1.460 3.965 0.046 18.306 1.047~321.108 注：病变点数≥3，否=0，是=1；病变累腺，否=0，是=1；流产次数≥2次，否=0，是=1。
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表 3 影响绝经后女性HSIL全子宫切除术后升级为宫颈癌的单因素分析
(例) 组别 例数 接触性出血 病变点数(点) 病变累及腺体 产次(次) 流产次数(次) 是否行宫颈管搔刮 绝经年限(年) HPV高危型感染 (+) (-) ≥3 < 3 是 否 ≥2 < 2 ≥2 < 2 是 否 ≥5 < 5 有 无 浸润组 20 5 15 10 10 12 8 17 3 4 16 1 19 11 9 17 3 未浸润组 93 40 53 22 71 33 60 80 13 12 81 12 81 27 66 76 17 χ2值 2.229 5.628 4.128 0.014 0.682 0.101 4.973 0.285 P值 0.136 0.018 0.042 0.905 0.409 0.315 0.026 0.593
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表 4 影响绝经后女性HSIL全子宫切除术后升级为宫颈癌的多因素分析
变量 B SE Wald χ2 P值 OR值 95%CI 病变点数 1.197 0.547 4.789 0.029 3.311 1.133~9.675 病变是否累腺 1.442 0.580 6.171 0.013 4.228 1.356~13.188 绝经年限 1.483 0.578 3.965 0.010 4.407 1.419~13.687 注：病变点数≥3点，否=0，是=1；病变累腺，否=0，是=1；绝经年限≥5年，否=0，是=1。
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