宫颈癌术后人乳头瘤病毒未清除影响因素及对预后的影响

Influencing factors of human papillomavirus after cervical cancer surgery and its effect on prognosis

目的探讨宫颈癌术后人乳头瘤病毒(HPV)未清除的影响因素及对预后的影响。方法选取2017年1月至2020年1月于本院就诊治疗的宫颈癌患者345例,记录术后HPV清除情况。随机选择HPV清除患者40例作为对照组,3年内HPV未清除患者40例作为研究组,并应用单因素及多因素Logistics分析宫颈癌患者HPV未清除的危险因素,统计生存时间<3年及盆腔复发情况,比较两组预后情况。结果术后3年内,HPV清除率为88.41%,HPV未清除率为11.59%;单因素分析结果显示,年龄、肿瘤分化程度、肌层浸润深度、手术类型、术后接受辅助治疗、淋巴结转移6个因素与HPV清除相关(P<0.05)。多因素Logistics回归分析表明,年龄和手术方法应用筋膜外全子宫切除术是宫颈癌术后HPV未清除的危险因素,术中卵巢保留和术后接受辅助治疗是保护因素(P<0.05);研究组生存时间<3年和盆腔复发率明显高于对照组,差异有统计学意义(P<0.05)。结论宫颈癌术后HPV转归,年龄和筋膜外全子宫切除术是独立影响因素,术中卵巢保留和术后接受辅助治疗是保护因素,HPV转归可有效改善患者预后。

Objective To explore the influencing factors of human papilloma virus(HPV) after cervical cancer surgery and its influence on prognosis. Methods 345 patients with cervical cancer who were treated in our hospital from January 2017 to January 2020 were included, and postoperative HPV clearance was recorded. 40 patients with HPV clearance were randomly selected as the control group, 40 patients who did not clear HPV within 3 years were selected as the study group. Univariate and multifactorial Logistics were used to analyze the risk factors for uncleared HPV in cervical cancer patients. Statistical survival time<3 years and pelvic recurrence were compared between two groups. Results Within 3 years, the clearance rate of HPV was 88.41%, and the clearance rate of HPV was 11.59%. The univariate analysis showed that age, tumor differentiation degree,myometrial invasion depth, type of surgery, postoperative adjuvant treatment, and lymph node metastasis were related to HPV clearance(P<0.05).Multivariate Logistic regression analysis showed that age and surgical methods with extrafascial hysterectomy were risk factors for HPV not cleared after cervical cancer. Ovarian retention during surgery and adjuvant treatment after surgery were protective factors(P<0.05). The rate with a survival time of <3 years and pelvic recurrence in the study group were higher than the control group and the difference was statistically significant(P<0.05). Conclusion HPV outcomes after cervical cancer, age and extrafascial hysterectomy are independent influencing factors. Intraoperative ovarian preservation and postoperative adjuvant therapy are protective factors. HPV outcomes can effectively improve the prognosis of patients.