Risk factors associated with adverse outcomes after cervical conization in patients with cervical adenocarcinoma in situ

TL;DR

This study identifies risk factors for poor outcomes after cervical conization in patients with cervical adenocarcinoma in situ, helping guide treatment decisions.

Contribution

The study identifies specific clinical risk factors for adverse outcomes after conization in ACIS patients.

Findings

Older age, abnormal ECC results, and multiple ACIS lesions increase the risk of positive surgical margins.

Multiparity and abnormal ECC results are linked to higher chances of residual lesions after conization.

Abnormal ECC results predict postoperative pathological upgrading in ACIS patients.

Abstract

Identifying high-risk groups for adverse outcomes after conization is crucial for developing targeted treatment plans for patients with cervical adenocarcinoma in situ (ACIS). This study aimed to analyze the clinical characteristics of patients with ACIS and identify risk factors associated with adverse outcomes.

Patients diagnosed with ACIS through colposcopic biopsy at the Affiliated Hospital of Qingdao University and Qilu Hospital between January 2012 and December 2022 were selected. After meeting the inclusion and exclusion criteria, we collected their clinical data. Chi-square (χ2) tests and logistic regression models were employed to determine independent risk factors.

A total of 379 patients with ACIS were included in this analysis. About 26.1% of these patients tested positive on preoperative endocervical curettage (ECC), while 79.4% had a single lesion. Among the 334 patients who underwent cervical conization, 17.1% had positive surgical margins. Additionally, residual lesions were present in 53.6% of cases, and pathological upgrading occurred in 7.8% of patients. Multivariate analysis indicated that age (p < 0.001), preoperative histopathological results from ECC (p = 0.033), and the number of ACIS lesions (p < 0.001) were associated with positive surgical margins. Number of births (p = 0.011), preoperative histopathological results from ECC (p = 0.030), and surgical margin statuses at cervical conization (p < 0.001) were independent risk factors for residual lesions. Preoperative histopathological result of ECC (p = 0.035) was confirmed as a predictor of postoperative pathological upgrading.

Older, multiparous patients with ACIS and abnormal preoperative ECC results require deeper diagnostic excision. Patients with positive conization margins necessitate further treatment, particularly when accompanied by abnormal ECC results. For women who wish to preserve their fertility, a repeat conization may be appropriate; however, in older and multiparous women, a hysterectomy would be recommended.

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