Analysis of Influencing Factors and Predictive Model for Postoperative Recur-rence of Cervical High-Grade Squamous Intraepithelial Lesions Treated with Loop Electrosurgical Excision Procedure in Broussonetia Papyrifera
- VernacularTitle:子宫颈高级别鳞状上皮内病变患者行子宫颈环形电切除术后复发的影响因素分析及预测模型构建
- Author:
Wenyan HE
1
;
Yingpei WANG
;
Han LI
Author Information
1. 中国人民解放军联勤保障部队第九八一医院妇产科,河北承德 067000
- Publication Type:Journal Article
- Keywords:
Cervix uteri;
High-intensity squamous intraepithelial lesions;
Loop electrosurgical excision proce-dure;
Prognosis;
Influencing factors;
Nomogram
- From:
Journal of Practical Obstetrics and Gynecology
2025;41(7):605-609
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Analyze the influencing factors of postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix undergoing loop electrosurgical excision procedure,establish a no-mogram prediction model,and conduct internal and external validation.Methods:A total of 200 patients with high-grade squamous intraepithelial lesions of the cervix collected from the 981st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2018 to May 2021 were selected as the study subjects,serving as the modeling set.Based on whether patients relapsed within 2 years after treatment,they were divided into the relapse group(n=36)and the non-relapse group(n=164).A logistic regression risk model was used to analyze the influencing factors of postoperative recurrence in patients with high-grade squa-mous intraepithelial lesions of the cervix;internal data were employed to validate the clinical efficacy of the nomo-gram model.Following the principle that the validation set sample size should account for 30％of the total sample size,86 patients with high-grade squamous intraepithelial lesions of the cervix treated at our hospital from June 2021 to June 2022 were collected as the validation set for external validation of the model.Results:Compared with the non-relapse group,the relapse group had a higher proportion of patients with persistent high-risk human papil-lomavirus(HR-HPV)infection,glandular involvement,multi-quadrant involvement,and positive margin status,showing statistically significant differences(P＜0.05).Logistic regression analysis revealed that persistent postop-erative HR-HPV infection,glandular involvement,multi-quadrant involvement,and margin status were independent influencing factors for postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix(P＜0.05).Using these four factors as indicators,a nomogram model was constructed.The calibration curve analysis of the modeling set showed that the C-index of the predictive model for postoperative recurrence was 0.740(95％CI 0.655-0.825).Decision curve analysis demonstrated that when the risk threshold exceeded 0.08,the nomogram-based intervention provided greater clinical net benefit.The calibration curve analysis of the validation set showed that the C-index of the predictive model for postoperative recurrence was 0.788(95％CI 0.674-0.812).Decision curve analysis indicated that when the risk threshold exceeded 0.06,it could offer grea-ter clinical net benefit.ROC curve analysis revealed an AUC of 0.904(95％CI 0.795-1.000).The Hosmer-Leme-show goodness-of-fit test yielded x2=9.342,P=0.155(P＞0.05).Conclusions:The nomogram prediction model constructed based on postoperative HR-HPV persistent infection,glandular involvement,multi-quadrant involve-ment,and margin status of Broussonetia papyrifera demonstrates good predictive value for postoperative recur-rence in patients.
