OBJECTIVE: To explore appropriate treatment modality of microinvasive cervical cancer (MIC) and to analyze prognosis and risk factors of recurrence. METHODS: A cohort of 324 Chinese patients with MIC diagnosed and treated at Peking Union Medical College Hospital was retrospectively reviewed. Demographic features, treatment modalities, pathologic parameters, risk factors of residual disease, survival and risk factors of recurrence were analyzed. RESULTS: Of all patients, 280 cases were staged IA1 and 44 cases staged IA2 MIC. Twenty-five cases (7.7%) were found to have lympho-vascular space involvement (LVSI), but no parametrial involvement or ovarian metastasis was detected. Only one staged IA2 patient with LVSI was found to have lymph node metastasis. 32.4% patients (82/253) had residual diseases after conization. No significant difference of LVSI, lymph node metastasis and residual disease after coniztion was found between stage IA1 and IA2 MIC patients. Multivariate logistic analysis showed positive margin was the only independent risk factor of residual disease after conization (odds ratio [OR], 4.18; p<0.001). Recurrence occurred in five cases, but no mortality was found. Progression-free survival for stage IA1 patients treated by conization or hysterectomy was similar (92.3% and 98.8%, p=0.07). Cox regression analysis revealed LVSI as an independent risk factor for recurrence in stage IA1 patients (OR, 12.14; p=0.01). CONCLUSION: For stage IA1 patients with negative resection margin and no LVSI, conization can be an ideal treatment modality. For stage IA2 patients, more conservative surgery such as simple hysterectomy may be considered. LVSI is an independent risk factor for recurrence in patients with stage IA1 cervical cancer.
Adult ; Aged ; Cohort Studies ; Conization/methods ; Female ; Humans ; Hysterectomy ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Neoplasm, Residual ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Uterine Cervical Neoplasms/pathology/*surgery ; Young Adult

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Objective:To investigate the proportion of hepatitis B-related hepatocellular carcinoma (HCC) patients who have received antiviral therapy and compare the clinical characteristics of HCC patients who have received antiviral therapy with those who have not received antiviral therapy.Methods:Data of 2590 newly diagnosed hepatitis B-related HCC cases who were hospitalized in Nanfang Hospital from 2015 to 2017 were collected. Two independent sample t-tests, Mann-Whitney U test, and χ2 test were used to compare the clinical characteristics of hepatitis B-related HCC patients who had received antiviral therapy and those who had not received antiviral therapy. Propensity score was used to match some clinical characteristics of the two groups of patients, and the differences in clinical characteristics of the two groups of patients after matching were further compared. Patients with HCC who had not received antiviral therapy were used as reference, and then the clinical characteristics of HCC patients who had received antiviral treatment were analyzed using multivariate logistic regression. Results:Among the 2 590 patients with hepatitis B-related HCC, only 18.10% of patients had received antiviral therapy, while 82.20% of patients who did not receive antiviral therapy met the treatment criteria. HCC patients who had received antiviral therapy were older ( P < 0.05), had a higher proportion of liver cirrhosis ( P < 0.001), and lower levels of platelets and alanine aminotransferases and smaller maximum tumor diameter ( P < 0.001). In terms of metabolic disease, patients who had received antiviral treatment had higher prevalence of diabetes (14.50% vs. 7.70%, P < 0.001), hypertension (16.60% vs. 11.20%, P < 0.05), obesity (28.50% vs. 22.30%, P < 0.05), overweight (53.80% vs. 43.50%, P < 0.001) and non-alcoholic fatty liver disease (18.30% vs.8.00%, P < 0.001). After matching other different clinical characteristics, the prevalence of diabetes, hypertension, and non-alcoholic fatty liver disease in patients who received antiviral therapy was still higher than that of patients who did not receive antiviral therapy (14.50% vs. 9.80%, P < 0.05; 16.60% vs. 10.20%, P < 0.05; 18.30% vs. 7.00%, P < 0.001). Multivariate logistic regression analysis showed that HCC patients who had received antiviral therapy had a higher risk of developing non-alcoholic fatty liver disease ( OR: 2.054, 95% CI: 1.404~3.004) than those who had not received antiviral therapy. Conclusion:Among patients with hepatitis B-related HCC, the proportion of patients who have received antiviral therapy is significantly low (under 20%), which suggests that the popularization and promotion of antiviral therapy has a long way to go. Compared with HCC patients who have not received antiviral therapy, the proportion of HCC patients who have received antiviral therapy combined with metabolic diseases is higher; therefore, it is necessary to pay more attention to the role of metabolic factors in the pathogenesis of hepatitis B-related HCC.