Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study
Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study
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DOI：
10.1016/j.ejogrb.2012.06.026
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发表时间：
2012-11-01
影响因子：
2.6
通讯作者：
Ghezzi, Fabio
中科院分区：
文献类型：
--
作者：
Serati, Maurizio;Siesto, Gabriele;Ghezzi, Fabio
目的：探讨宫颈锥切术后宫颈上皮内瘤变（CIN）复发的危险因素。研究设计：连续招募了组织学证实的CIN患者，他们接受了冷刀锥切术或环形电切术，并计划在10年期间进行系列随访检查。数据存储在数字数据库中。进行多因素分析以确定复发的因素。结果：1999年1月至2009年12月，282例患者符合纳入标准，纳入最终统计分析。中位随访26.7个月（范围6-100）后，64名（22.7%）女性发生组织学证实的复发。阴性和阳性切缘的2年无复发生存率分别为83.7%和66.7% （p = 0.008）。切缘阴性和阳性患者的5年无复发生存率分别为75.4%和50.3% （p = 0.0004）。手术切缘阳性是复发最重要的独立预测因子[HR 2.5 (95%CI 1.5-4.5), p = 0.0007: Wald 11.338]。多项logistic回归后，基于持续CIN1的锥化指标是阴性切缘的唯一独立预测指标[OR 0.3 (95%CI 0.1-0.7), p = 0.008]。结论：我们的研究表明，手术切缘状态是锥化后CIN复发的最重要预测因素。切除治疗后，密切随访是必要的，以便及早发现复发性疾病。确定复发的危险因素可以指导临床决定是采取预期治疗还是再干预。2012爱思唯尔爱尔兰有限公司版权所有。
Objective: To evaluate the risk factors potentially involved in the development of cervical intraepithelial neoplasia (CIN) recurrence after cervical conization in a long-term follow-up period.Study design: Consecutive patients with histologically proven CIN who had undergone either cold knife conization or a loop electrosurgical excision procedure were enrolled and scheduled for serial follow-up examinations over a 10-year period. Data were stored in a digital database. Multivariate analysis was performed to identify factors for recurrence.Results: Between January 1999 and December 2009, 282 patients fulfilled the inclusion criteria and were included in the final statistical analysis. After a median follow-up of 26.7 months (range 6-100), 64 (22.7%) women developed histologically confirmed recurrence. The 2-year recurrence-free survival was 83.7% and 66.7% for women with negative and positive margins, respectively (p = 0.008). The 5-year recurrence-free survival was 75.4% and 50.3% for patients with negative and positive margins, respectively (p = 0.0004). Positive surgical margin was the most important independent predictor of recurrence [HR 2.5 (95%CI 1.5-4.5), p = 0.0007: Wald 11.338]. After multinomial logistic regression the indication for conization based on persistent CIN1 was the only independent predictor for negative margin [OR 0.3 (95%CI 0.1-0.7), p = 0.008].Conclusions: Our study demonstrated that the surgical margin status represents the most important predictor for CIN recurrence after conization. After excisional therapy, close follow-up is mandatory for the early detection of recurrent disease. The identification of risk factors for recurrence may guide clinical decision-making on expectant management versus re-intervention. (C) 2012 Elsevier Ireland Ltd. All rights reserved.