摘要
目的:建立宫颈上皮内瘤变(CIN)患者宫颈环形电切术(LEEP)术后复发的预测列线图并验证其效能。方法:选取2015年5月至2018年5月在陆军军医大学第一附属医院诊断及行LEEP治疗的CIN患者1204例,根据随访期内CIN是否复发分为复发组与未复发组,比较两组一般资料及LEEP术相关资料,包括高危人乳头瘤病毒(HR-HPV)、液基薄层细胞学(TCT)、术后病理结果,使用Logistic回归模型分析影响复发的独立危险因素,使用R软件建立复发列线图预测模型,并验证其效能。结果:共发生CIN复发85例,复发组和未复发组患者的一般资料比较,无明显差异(P>0.05);复发组在术前HR-HPV感染、CIN分级(Ⅱ级、Ⅲ级)、手术切缘阳性、病变累及腺体的比例显著高于未复发组(P<0.05);HR-HPV感染(OR=1.941,P=0.016)、CINⅢ级(OR=2.649,P=0.000)、手术切缘阳性(OR=11.524,P=0.000)、病变累及腺体(OR=8.330,P=0.000)是复发发生的独立危险因素;列线图预测复发发生的一致性指数(C-index)为0.922(95%CI:0.871~0.963)。结论:HR-HPV感染、CINⅢ级、手术切缘阳性、病变累及腺体等危险因素构建的列线图可有效预测CIN的复发,并具有较好的应用价值。
Objective:To establish a predictive nomogram for the recurrence of cervical intraepithelial neoplasia(CIN)after loop electrosurgical excision procedure(LEEP)and verify its efficacy.Methods:A total of 1204 CIN patients that diagnosed and treated with LEEP at the First Hospital Affiliated to Army Medical University from May 2015 to May 2018 were selected.According to whether CIN recurred during the follow-up period,the subjects were divided into a recurrence group(n=85)and a non-recurrence group(n=983).The general data and LEEP-related data of the two groups,including high-risk human papilloma virus(HR-HPV),liquid-based thin-layer cytology,and postoperative pathological results were compared.Logistic regression model was used to analyze independent risk factors that affected CIN recurrence.A predictive nomogram for CIN recurrence was established using R software and its efficacy was verified.Results:There were 85 CIN recurrences patients,and there was no significant difference between the general data of the recurrence group and the non-recurrence group(P>0.05).The proportions of HR-HPV infection before surgery,CIN classification(gradesⅡandⅢ),positive surgical margins,and gland involvement in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05).HR-HPV infection(OR=1.941,P=0.016),CINⅢgrade(OR=2.649,P=0.000),positive surgical margins(OR=11.524,P=0.000),and gland involvement(OR=8.330,P=0.000)were independent risk factors for CIN recurrence.The consistency index(C-index)of the nomogram for predicting CIN recurrence was 0.922(95%CI,0.871~0.963).Conclusion:Nomograms based on risk factors such as HR-HPV,CIN III,positive surgical margins,and gland involvement can effectively predict the recurrence of CIN and is worthy to application.
作者
徐燕
陈诚
任玉香
蔡惠芬
魏多思
刘佳
冯顺
张晓林
卢春冬
Xu Yan;Chen Cheng;Ren Yuxiang;Cai Huifen;Wei Duosi;Liu Jia;Feng Shun;Zhang Xiaolin;Lu Chundong(Department of Obstetrics and Gynecology,the First Hospital Affiliated to Army Medical University,Chongqing 400000)
出处
《广西医科大学学报》
CAS
2020年第2期282-286,共5页
Journal of Guangxi Medical University
基金
国基自然科学基金资助项(No.81673011,No.81101994)。
关键词
宫颈上皮内瘤变
宫颈环形电切术
列线图
预测模型
cervical intraepithelial neoplasia
loop electrosurgical excision procedure
nomogram
predictive model
