The patients’ characteristics
The clinicopathological characteristics of 453 AIS patients, including
153 underwent cervical conization(s) alone and 300 underwent cervical
conization followed by hysterectomy, were summarized in Table 1. There
were 97.93% of HPV positive and 67.39% of abnormal cytology,
respectively. The transformation zone was type III in 60.88% of the
patients and type I~II in 39.12% of the patients. The
initial conization margin was positive in 19.65% of the patients.
Pathologically, 145 patients were AIS only, 308 patients were cervical
AIS coexisting with CIN. The mean age was 34.54±5.59 years in patients
with cervical conization alone and 45.10±7.77 years in patients with
hysterectomy respectively. The flowchart of the study design was show in
Figure 1.
Residual
disease and its related factors
In 153 patients undergoing cervical conization alone, 143 had negative
margins and 10 had positive margins who received repeated conization. In
addition, 300 underwent further hysterectomy after conization, of those,
79 had positive margins and 221 had negative margins of conization.
Thus,
the overall rate of residual diseases was 16.13% in 310 specimens of
hysterectomy and repeated conization. The rate of residual disease was
50.56% (45/89) for positive margins and 2.26% (5/221) for negative
margins, respectively, with a significantly difference (p=0.000). In
specimens with positive margins, 45 cases had residual diseases
including 31 AIS, 9 CIN 2/3, and 5 (5/89, 5.62%) invasive
adenocarcinoma. In specimens with negative margins, 5 cases had residual
diseases including 4 AIS, 1 CIN 1, and 0 (0/221, 0%) invasive
adenocarcinoma. The difference in the residual invasive carcinoma rate
between patients with positive and negative conization margins was
statistically significant (5.62% vs 0%, p=0.000).
The risk factors influencing residual disease were further analyzed by
univariate (Table 2) and
multivariate
analysis.
The results showed that pre-operative cytology (p=0.012), conization
method (p=0.011),
cone
length (p=0.008), and positive margin (p=0.000) were significantly
associated with residual disease, but only conization margin was the
independent factor influencing residual disease (OR=0.018, 95% CI
0.006-0.060).