Adenocarcinoma in situ or early-stage cervical cancer is a risk factor for preterm delivery after cervical conization: a multicenter observational study
Adenocarcinoma in situ or early-stage cervical cancer is a risk factor for preterm delivery after cervical conization: a multicenter observational study
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DOI：
10.1080/14767058.2022.2056835
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发表时间：
2022-03-26
影响因子：
1.8
通讯作者：
Aoki，Daisuke
中科院分区：
文献类型：
--
作者：
Kasuga，Yoshifumi;Ikenoue，Satoru;Aoki，Daisuke
宫颈锥切术后妊娠与早产的高风险相关。然而，由于锥切术后早产的风险因素仍然未知，我们进行了一项多中心的观察性研究，以调查与早产的风险因素。MethodsWe选择了患者谁曾接受锥切术，并回顾了2013年1月至2019年12月期间与庆应义塾大学医学院合作的18家医院的病历。妇女被归类为未经产和经产，并进行多元Logistic回归分析，以评估早产（即分娩前37孕周）的各种产妇危险因素的相对贡献。早产组的未产妇发生率（p= 0.014）高于足月分娩组，早产史（p= 0.0010）更常见。此外，早产组中诊断为原位腺癌（AIS）和宫颈癌的妇女比例高于足月分娩组（分别为p= 0.0099和0.0004）。在未产妇的多元回归模型中，宫颈癌或AIS（比值比[OR]：4.16，95%CI：1.26- 13.68，p = 0.019）和中期妊娠的短宫颈（OR：13.41，95%CI：3.88- 46.42，p <0.0001）增加了早产的风险。此外，早产史（OR：7.35，95% CI：1.55- 34.86，p = 0.012），宫颈癌或AIS（OR：5.07，95%CI：1.24- 20.73，p = 0.024），以及孕中期宫颈短（OR：4.29，95%CI：1.11- 16.62，p = 0.035）在多元回归模型中增加了早产的风险。AIS和宫颈癌的组织学类型被评估为早产的危险因素。关键信息既往早产、存在短宫颈、宫颈癌或AIS是锥切术后早产的预测因素。宫颈癌或AIS组的锥切深度明显大于CIN组。
ObjectivePregnancy after conization is associated with a high risk of preterm delivery. However, because risk factors for preterm delivery after conization remain unknown, we conducted a multicenter observational study to investigate risk factors associated with preterm delivery.MethodsWe selected patients who had previously undergone conization and reviewed medical records from 18 hospitals in cooperation with Keio University School of Medicine between January 2013 and December 2019. Women were classified as nulliparous and primiparous, and a multiple logistic regression analysis was performed to evaluate the relative contributions of the various maternal risk factors for preterm delivery (i.e. delivery before 37 gestational weeks).ResultsAmong 409 pregnant women after conization, 68 women delivered preterm (17%). The incidence of nulliparity (p= .014) was higher and a history of preterm delivery (p= .0010) was more common in the preterm delivery group than in the term delivery group. Furthermore, the proportion of women diagnosed with adenocarcinomain situ(AIS) and cervical cancer in the preterm delivery group was higher than that in the term delivery group (p= .0099 and .0004, respectively). In multiple regression models in nulliparous women, cervical cancer or AIS (Odds ratio [OR]: 4.16, 95% CI: 1.26–13.68,p= .019) and a short cervix in the second trimester (OR: 13.41, 95% CI: 3.88–46.42,p< .0001) increased the risk of preterm delivery. Furthermore, a history of preterm delivery (OR: 7.35, 95% CI: 1.55–34.86,p= .012), cervical cancer or AIS (OR: 5.07, 95% CI: 1.24–20.73,p= .024), and a short cervix in the second trimester (OR: 4.29, 95% CI: 1.11–16.62,p= .035) increased the risk of preterm delivery in the multiple regression models in primiparous women.ConclusionPregnant women who previously underwent conization are at risk for preterm delivery. The histological type of AIS and cervical cancer was evaluated as a risk factor for preterm delivery.KEY MESSAGESPrior preterm delivery, presence of a short cervix, and cervical cancer or AIS were predictors of preterm delivery after conization.The depth of conization in cervical cancer or AIS group was significantly larger than that in the CIN group.