高级别宫颈鳞状上皮内病变冷刀锥切术后复发的危险因素分析及其风险模型建立OA

Objective To determine the risk factors and develop a risk prediction model for recurrence after cold knife conization(CKC)in patients with high-grade cervical squamous intraepithelial lesion(HSIL).Methods A retrospective analysis was conducted on the clinical data of 270 patients with HSIL treated with CKC at the Liaoning Provincial People's Hospital from January 2018 to September 2023.A chi-square test was used to compare the differences in clinical indicators between the recurrence group(n=28)and the non-re-currence group(n=242).Cox univariate and multivariate regression analyses were performed to identify the risk factors for postopera-tive recurrence,and a recurrence risk prediction model was constructed.The predictive efficacy of each risk factor and the overall model was evaluated using receiver operating characteristic(ROC)curves.Results Compared with the non-recurrence group,the recurrence group showed a significantly higher proportion of patients with initial sexual intercourse at age<18 years,CINⅢgrade,positive surgical margins,persistent high-risk human papilloma virus(HPV)infection postoperatively,multi-quadrant lesions,glandular involvement,and strong positive expression of ENO1 and TOP2A(all P<0.05).The results of univariate Cox regression indicated that these risk fac-tors were all significantly associated with an increased risk of recurrence(all P<0.05).Multivariate Cox regression analysis revealed that persistent high-risk HPV infection,positive surgical margins,glandular involvement,and strong positive expression of TOP2A were independent risk factors for recurrence(all P<0.05).A recurrence risk prediction model was successfully constructed.The concordan-ce index(after bootstrap correction)of the nomogram model was 0.844.ROC curve analysis showed that the predictive model based on the four indicators of persistent HPV infection,positive surgical margins,glandular involvement,and strong positive expression of TOP2A had a higher predictive accuracy(area under the curve=0.851)than that of any single indicator(DeLong test,all P<0.05).Conclusion Persistent HPV infection,positive surgical margins,glandular involvement,and strong positive expression of TOP2A were independent risk factors for recurrence after CKC in patients with HSIL.Therefore,a thorough preoperative assessment of the surgical resection range and depth,along with enhanced follow-up and management of high-risk populations postoperatively,may help reduce the risk of recur-rence.