微小浸润癌宫颈锥切术后分子标志物水平及子宫病灶残留影响因素分析

Molecular marker levels and factors influencing residual uterine lesions after cervical conization for microinvasive carcinoma

目的探讨微小浸润癌宫颈锥切术后分子标志物水平及子宫病灶残留的影响因素。方法选取2017年6月至2020年6月间神木市医院收治的行宫颈锥切术的127例微小浸润癌患者为研究组,另选取60名健康体检者为对照组,采用免疫组化法对两组受试者P16和Ki67进行检测,采用单因素和多因素Logistic回归分析宫颈锥切术后子宫病灶残留与患者病理特征的相关性。结果研究组患者P16阳性127例(100.0%),对照组为0例(0.0%);研究组患者Ki67阳性114例(89.8%),对照组为0例(0.0%),差异均有统计学意义(均P<0.05)。患者宫颈切缘和HPV16/18为子宫病灶残留的影响因素,差异有统计学意义(P<0.05);患者年龄、是否绝经、产次、临床分期、血清鳞状细胞癌抗原(SCC)水平、锥切方式、浸润情况和是否累及腺体与子宫病灶残留无相关性,差异有统计学意义(P>0.05)。多因素二元Logistic回归分析,宫颈边缘阳性和HPV16/18阳性为子宫病变残留的独立危险因素,差异有统计学意义(P<0.05)。结论分子标志物P16和Ki67能有效鉴定宫颈微小浸润癌,为临床提供指导依据。HPV16/18感染和宫颈切缘阳性与子宫病灶残留密切相关,均为子宫病灶残留的独立危险因素,应当加强管理。

Objective To detect molecular marker levels and factors influencing residual uterine lesions after cervical conization for microinvasive carcinoma.Methods One hundred and twenty-seven patients with microinvasive carcinoma who underwent cervical conization at Shenmu Hospital from June 2017 to June 2020 were selected and included in a the study group.Another 60 individuals who had physical examination were selected and included in a control group.P16 and Ki67 were detected using immunohistochemical method.Univariate and multivariate logistic analyses were used to investigate the association between residual uterine lesions after cervical conization and pathologic characteristics.Results The P16-positive was reported in 127 patients in the study group(100.0%)and 0 in the control group(0.0%)(P<0.05).The Ki67-positive was reported in 114 patients in the study group(89.8%),which was higher than 0 of the control group(0.0%)(P<0.05).Cervical margin and HPV16/18 were independent risk factors for residual uterine lesions(all P<0.05).However,age,menopause,parity,clinical stage,preoperative serum squamous cell carcinoma antigen(SCC)levels,tangent cone,infiltration,whether the gland is affected were not associated with residual uterine lesions.Multivariate binary logistic regression analysis found that cervical margin-positive and HPV16/18-positive were independent risk factors for residual uterine lesions(all P<0.05).Conclusion The molecular markers P16 and Ki67 can effectively identify cervical microinvasive carcinoma providing guidance for clinical practice.HPV16/18 and cervical margin-positive were associated with residual uterine lesions,and were independent risk factors for residual uterine lesions.Strengthened management is warranted.