
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-24-03533
00009
10.1097/MD.0000000000039564
3
5600
Research Article
Observational Study
Postoperative clearance of high-risk human papillomavirus for patients with high-grade squamous intraepithelial lesion: Conization versus hysterectomy
Liu Xinglin MM 519263422@qq.com
ab
Fang Chunling MM 2568415032@qq.com
c
Hu Wenhao MM 765367895@qq.com
ab
Su Chang MM 294337826@qq.com
ab
Xu Fan MD xufanyidingxin@163.com
c
Hu Huiquan MM 765367895@qq.com
c
https://orcid.org/0000-0001-9193-3014
Li Chengzhi MD ab*
a State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
b Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
c Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, China.
* Correspondence: Chengzhi Li, State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China (e-mail: liChengzhi@cqmu.edu.cn).
06 9 2024
06 9 2024
103 36 e3956402 4 2024
09 8 2024
14 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

To compare the clearance rate of high-risk human papillomavirus (HR-HPV) in patients with high-grade squamous intraepithelial lesion (HSIL) after 2 different treatments (conization vs hysterectomy), and investigate the influencing factors. A retrospective cohort was established in HSIL patients with HR-HPV infection treated with conization or hysterectomy from July 2020 to May 2022. Age matching (1:1) was conducted between conization group and hysterectomy group. Chi-square test and t-test were employed to compare baseline and clinical characteristics between the 2 groups (conization vs hysterectomy). In addition, univariate and multivariate logistic regression analyses were conducted to compare the influencing factors for HR-HPV clearance at 6 months after surgery. The HR-HPV clearance rates at 6 months were 70.6% and 73.8% in conization group and hysterectomy group in the matched groups, respectively (P = .755). Similarly, at 12 months, the clearance rates were 78.6% and 76.5% in the matched groups, respectively (P = .844). Considering different age groups among all patients, the HR-HPV clearance rates were 81.8%, 72.9%, 73.5%, and 53.6% in the 20 to 30-year, 31 to 40-year, 41 to 50-year and 51 to 60-year groups at 6 months, respectively, and the clearance rates were 87.5%, 80.6%, 84.5% and 52.9% at 12 months, respectively. For HSIL, the postoperative HPV clearance rates were similar between the 2 groups (conization vs hysterectomy), conization is enough to resect the lesion and eliminate HPV. In addition, we should pay attention to the postoperative HR-HPV status in the older population of the 2 groups.

clearance rate
conization
high-grade squamous intraepithelial lesion
human papillomavirus
hysterectomy
OPEN-ACCESSTRUE
==== Body
pmcKeypoint

Compared with conization, hysterectomy did not increase the clearance rate of HR-HPV for HSIL patients, but increased the operation time, intraoperative blood loss and hospitalization expenses, in addition, we should pay attention to the postoperative HR-HPV status in the older population.

1. Introduction

Cervical cancer ranks the top among malignant tumors of the female reproductive system, which has posed a great threat to the health and life of women.[1] High-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia grade 2 to 3 (CIN2–3) is a precancerous lesion of cervical cancer, and the prompt treatment of HSIL is of great significance to block the disease progression.[2] Cervical conization (including loop electrosurgical excision procedure [LEEP] and cold-knife conization [CKC]) is the common method used to treat women with HSIL, but there is a risk of residual and recurrence after conization, as reported that 29% to 57% of HSIL patients undergoing hysterectomy after conization have residual HSIL.[2–4] While hysterectomy is not recommended as the preferred treatment, only used in selected cases, based on evaluation of the difficulty in conization excision, whether to receive strict follow-up, the uterus and fertility sparing requirements, patients’ attitudes and other indications for hysterectomy.[2,5]

High-risk human papillomavirus (HR-HPV) infection is not only the main cause of HSIL and cervical cancer, but also the main influencing factor for predicting local residual and the recurrence of CIN after surgery.[6–9] According to the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) Risk-Based Management Consensus Guidelines, HR-HPV is the main follow-up method after cervical resection treatment.[2] Therefore, the postoperative HPV status is the key point in follow-up.

Current studies have reported that the HPV clearance rate after conization ranges from 50.5% to 93.7% at 6 to 12 months,[10–12] and a few studies find that the HPV clearance rate after hysterectomy is 81.2% to 82.3% at 12 months.[13,14] However, data comparing the HPV clearance rate between the 2 groups are lacking. Therefore, this study aimed to compare the clearance rate of HR-HPV in patients with HSIL after 2 treatments (conization vs hysterectomy), and investigate the associated influencing factors.

2. Materials and methods

This study was approved by the Ethics Committee of Nanchong Central Hospital (Protocol number: 2022-009). From July 2020 to May 2022, patients diagnosed with pathologically confirmed HSIL by colposcopic biopsy in Nanchong Central Hospital were retrospectively analyzed. All the patients signed an informed consent form. Patients were counseled about the treatment methods. Then, they chose whether to receive conization or hysterectomy.

Inclusion criteria: (i) cervical biopsy results were HSIL and HR-HPV test was positive; (ii) complete clinical data were available and patients receiving at least one follow-up during 12 months; and (iii) non-pregnant and non-lactating women.

Exclusion criteria: (i) patients who received adjuvant therapy or other treatment after conization or hysterectomy; (ii) patients undergoing physical therapy and surgery for cervical disease in the past year; (iii) patients with recurrent HSIL; (iv) patients with preoperative vaginal or vulvar intraepithelial neoplasia; and (v) patients with serious heart, liver, kidney, blood system, and HIV/AIDS or autoimmune disease.[12]

Conization group: all patients were given general anesthesia and placed in the lithotomy position. The resection was performed clockwise with a cold-knife or with a loop electrode and an electrosurgical unit (WALLACH Biovac Quantum2000 Electrosurgical Unit, USA) in a blended model consisting of a 50 W cutting current and 25 W coagulation. The surgery was consisted of a standardized procedure.[15]

Hysterectomy group: the surgical procedure consisted of a standardized total laparoscopic hysterectomy by using a laparoscopic surgical system (Karl Storz Endoskope, Tuttlingen, Germany).[16]

Postoperative HPV test (Shanghai ZJ Bio-Tech Co., Ltd., China) and Thinprep cytologic test (TCT, Hologic Inc., USA) were conducted at 6 and 12 months. Patients were advised to keep the perineum clean; sexual intercourse within 24 hour and the application of vaginal suppository within 3 days before test were not advised. We advised patients to use condoms during sexual intercourse in follows-up. If HPV and Thinprep cytologic test results[17] were abnormal, patients underwent repeated colposcopy, and further treatment was conducted in line with the guidelines.[2]

Age matching (1:1) was conducted between conization group and hysterectomy group. For each case, one control was selected and matched on age (±2 year). Normally distributed data were reported as mean ± standard deviation and non-normally distributed data were reported as the median (range). Categorical data were expressed as numerals and percentages (%). Chi-square test, Mann–Whitney U test, and independent-sample t test were used to compare baseline demographics and clinical characteristics between 2 groups. To evaluate the association between variables and HR-HPV clearance, binary logistic regression was utilized to calculate the odds ratios (ORs) with 95% confidence intervals (CIs). P < .05 was considered statistically significant upon the two-sided test. All data analysis was completed using SPSS 27.0 software (IBM, Armonk, NY).

3. Definitions

To better describe the distribution of HR-HPV, the HPV types were divided into the following types according to previous literature: HPV16/18 infection: single type or co-infection with HPV16/18; non-HPV16/18 infection: single type or co-infection without HPV16/18[18]; single infection: single type infection with or without HPV16/18; double infection: 2 type infection with or without HPV16/18; triple or more infection: 3 or more type infection with or without HPV16/18.[19]

4. Results

Medical records of 332 women diagnosed with HSIL were searched. Based on the predetermined inclusion and exclusion criteria, totally 285 patients were involved, including 171 receiving conization and 114 undergoing hysterectomy. Meanwhile, 63 pairs of age-matched patients were obtained. Figure 1 presents the patient selection process through the study design. Table 1 displays the baseline demographics and clinical characteristics of the unmatched groups and matched groups. Obviously, for the matched patients, the operation time was 20 (10–150) min versus 80 (55–214) min (P < .001), the intraoperative blood losses were 5 (1–50) mL versus 50 (10–200) mL (P < .001), and the hospitalization expenses were 6747.23 ± 3977.09 Chinese Yuan versus 20328.78 ± 3486.15 Chinese Yuan (P < .001), respectively, in the conization group and hysterectomy group. There were no statistically significant differences in average age, body mass index, the menopausal status, gravidity, parity, marriageable age, HR-HPV type, or cytological findings.

Table 1 Baseline demographics and clinical characteristics of patients in unmatched and matched groups.

	Unmatched groups	Matched groups	
Conization group (n = 171)	Hysterectomy group (n = 114)	P value	Conization group (n = 63)*	Hysterectomy group (n = 63)*	P value	
Age (years)	38.36 ± 8.92	51.98 ± 6.91	P < .001†	47.32 ± 5.57	48.05 ± 5.24	0.872†	
BMI (kg/m2)	22.17 ± 2.09	23.08 ± 2.54	0.019†	22.92 ± 2.14	23.33 ± 2.15	0.532†	
Gravidity			0.697‡			0.469‡	
 <3	97 (56.7%)	62 (54.4%)		24 (53.3%)	38 (60.3%)		
 ≥3	74 (43.3%)	52 (45.6%)		21 (46.7%)	25 (39.7%)		
Parity			0.054‡			0.308‡	
 <2	46 (26.9%)	43 (37.7%)		52 (91.2%)	31 (96.9%)		
 ≥2	125 (73.1%)	71 (62.3%)		5 (8.8%)	1 (3.1%)		
Marriageable age (years)	22.14 ± 3.20	21.41 ± 2.52	0.066†	21.66 ± 3.53	21.52 ± 2.87	0.819†	
Menopause status			P < .001†			0.693‡	
 YES	17 (9.9%)	58 (50.9%)		17 (27.0%)	19 (30.2%)		
 NO	154 (90.1%)	56 (49.1%)		46 (73.0%)	44 (69.8%)		
HR-HPV types			0.066‡			0.051‡	
 HPV16/18 infection	77 (45%)	64 (56.1%)		26 (41.3%)	37 (58.7%)		
 Non-HPV16/18 infection	94 (55%)	50 (43.9%)		37 (58.7%)	26 (41.3%)		
Cytological findings			P < .001‡			0.373‡	
 NILM/ASCUS/LSIL	84 (57.5%)	33 (34.4%)		28 (50.9%)	22 (42.3%)		
 ASC-H/HSIL/AGC	62 (42.5%)	63 (65.6%)		27 (49.1%)	30 (57.7%)		
 Operation time (min)	20 (5–150)	85 (55–214)	P < .001§	20 (10–150)	80 (55–214)	P < .001§	
 Intraoperative blood loss (mL)	5 (1–50)	50 (10–200)	P < .001§	5 (1–50)	50 (10–200)	P < .001§	
 Hospitalization expense (CNY)	6747.23 ± 3977.09	20328.78 ± 3486.15	P < .001†	6504.24 ± 3285.24	20747.89 ± 3626.750	P < .001†	
AGC = atypical glandular cells, ASC-H = atypical squamous cells-cannot exclude HIS, ASCUS = atypical squamous cell of undetermined significance, HR-HPV = high-risk human papillomavirus, HSIL = high-grade squamous intraepithelial lesion, LSIL = low-grade squamous intraepithelial lesion, NILM = negative for intraepithelial lesion or malignancy.

* Case and control subjects were matched by age.

† By independent-sample t test;

‡ By Pearson chi-square test;

§ Mann–Whitney U test.

Figure 1. Flow diagram for patient selection. HSIL: high-grade squamous intraepithelial lesion. HR-HPV; high-risk human papillomavirus.

As shown in Figure 2, the most common infection was single infection (202/285, 70.9%), followed by double infection (67/285, 23.5%), and triple or more infection (16/285, 5.6%). The distribution of HR-HPV subtypes of single infection in the study population is listed in Figure 3. The most common subtype was HPV16 (40.1%), followed by HPV52 (20.8%), HPV58 (15.3%), HPV33 (9.9%), HPV18 (5.9%), and HPV31 (4%). According to Table 2, the HR-HPV clearance rates at 6 months were 73.1% and 68.2% in conization group and hysterectomy group, respectively, in the unmatched groups (P = .492), while 70.6% and 73.8% in the matched groups, respectively (P = .755). At 12 months, the clearance rates were 82.9% and 75.0% in conization group and hysterectomy group in the unmatched groups (P = .276), while 78.6% and 76.5%, respectively, in the matched groups (P = .844). The clearance rate of HR-HPV 16/18 infection at 6 months was 69.2% in conization group, and that was 75.0% in hysterectomy group in the matched groups (P = .706). At 12 months, the clearance rates of HR-HPV 16/18 infection were 78.6% and 80.0% in the matched groups, respectively (P = .919).

Table 2 Clearance rate of HR-HPV in unmatched and matched groups.

	Unmatched groups	Matched groups	
Conization group (n = 171)	Hysterectomy group (n = 114)	P value	Conization group (n = 63)*	Hysterectomy group (n = 63)*	P value	
Clearance rate of HR-HPV	
 6 months	76/104 (73.1%)	45/66 (68.2%)	0.492†	24/34 (70.6%)	31/42 (73.8%)	0.755†	
 12 months	68/82 (82.9%)	36/48 (75.0%)	0.276†	22/28 (78.6%)	26/34 (76.5%)	0.844†	
Clearance rate of HR-HPV 16/18 infection	
 6 months	37/44 (84.1%)	30/38 (78.9%)	0.548†	9/13 (69.2%)	18/24 (75.0%)	0.706†	
 12 months	33/39 (84.6%)	21/26 (80.8%)	0.685†	11/14 (78.6%)	16/20 (80.0%)	0.919†	
Clearance rate of Non-HR-HPV 16/18 HPV infection	
 6 months	57/76 (75.0%)	26/36 (72.2%)	0.754†	20/27 (74.1%)	20/22 (90.9%)	0.130†	
 12 months	48/57 (84.2%)	23/26 (88.5%)	0.610†	18/22 (81.8%)	16/17 (94.1%)	0.255†	
HR-HPV = high-risk human papillomavirus.

* Case and control subjects were matched by age.

† By Pearson’s chi-square test.

Figure 2. The infection rate of single types or multiple types in the study population. HR-HPV; high-risk human papillomavirus.

Figure 3. The distribution of HR-HPV subtypes of single infection in the study population. HR-HPV; high-risk human papillomavirus.

As shown in Table 3, univariate regression analysis was performed to compare the clinical data (6 variables including age, gravidity, parity, menopause status, HR-HPV types, and procedure methods) between HR-HPV-cleared group and HR-HPV-non-cleared group at 6 months after surgery, aiming to determine the relevant influencing factors for regression analysis. Therefore, differences in menopausal status (NO vs YES) (OR: 1.387, 95% CI: 0.607–3.128, P = .443), HR-HPV types (16/18 vs Non-16/18) (OR: 0.959, 95% CI: 0.494–1.863, P = .902), and procedure (conization vs hysterectomy) (OR: 1.267, 95% CI: 0.645–2.489, P = .493) were of no statistical significance (P > .05). According to multivariate regression analysis, after adjusting for various confounding factors, there were no statistically significant influencing factors for the clearance rate of HR-HPV infection at 6 months after surgery (P > .05). It was found from Table 4 that, for the different age groups in total patients, the HR-HPV clearance rates were 81.8%, 72.9%, 73.5%, and 53.6% in the 20 to 30-year, 31 to 40-year, 41 to 50-year and 51 to 60-year groups, respectively, at 6 months, while 87.5%, 80.6%, 84.5% and 52.9%, respectively, at 12 months. These results revealed that the HR-HPV clearance rate gradually decreased with increasing age.

Table 3 The regression analysis of HR-HPV clearance-related factors in unmatched and matched patients at 6 months after surgery.

Variable	Unmatched groups (n = 285)	Matched groups (n = 126)*	
OR	95% Cl	P value	OR	95% Cl	P value	
Univariate analysis	
 Age (years)	1.03	0.994–1.067	0.103	1.044	0.943–1.155	0.406	
 Gravidity (≥3 vs <3)	1.311	0.672–2.560	0.427	1.84	0.593–5.706	0.291	
 Parity (≥2 vs <2)	1.191	0.600–2.365	0.617	0.282	0.036–2.238	0.231	
 Menopause status (NO vs YES)	1.387	0.607–3.128	0.443	0.8	0.240–2.662	0.716	
 HR-HPV types (16/18 vs Non-16/18)	0.959	0.494–1.863	0.902	0.359	0.125–1.031	0.057	
 Procedure (conization vs hysterectomy)	1.267	0.645–2.489	0.493	0.852	0.311–2.335	0.755	
Multivariate analysis	
 Age (years)	1.045	0.990–1.103	0.113	1.052	0.885–1.251	0.563	
 Gravidity (≥3 vs <3)	1.355	0.680–2.697	0.388	3.252	0.649–16.283	0.151	
 Parity (≥2 vs <2)	1.144	0.566–2.314	0.708	0.243	0.011–5.207	0.366	
 Menopause status (NO vs YES)	0.841	0.289–2.447	0.75	0.968	0.117–8.020	0.976	
 HR-HPV types (16/18 vs Non-16/18)	0.912	0.460–1.811	0.793	0.342	0.066–1.778	0.202	
 Procedure (conization vs hysterectomy)	0.776	0.317–1.902	0.580	0.539	0.114–2.550	0.436	
CI = confidence interval, HR-HPV = high-risk human papillomavirus, OR = odds ratio.

* Case and control subjects were matched by age.

Table 4 Comparison of HR-HPV clearance rate in different age groups in total patients.

Age (years)	20 to 30	31 to 40	41 to 50	51 to 60	61 to 72	
Clearance rate of HR-HPV	
 6 months	18/22 (81.8%)	35/48 (72.9%)	50/68 (73.5%)	15/28 (53.6%)	3/4 (75%)	
 12 months	14/16 (87.5%)	29/36 (80.6%)	49/58 (84.5%)	9/17 (52.9%)	3/3 (100%)	
Clearance rate of HR-HPV 16/18 infection	
 6 months	13/13 (100%)	14/17 (82.4%)	29/35 (82.9%)	11/17 (64.7%)	/	
 12 months	10/10 (100%)	9/12 (75%)	28/32 (87.5)	6/10 (60%)	1/1 (100%)	
Clearance rate of Non-HR-HPV 16/18 infection	
 6 months	10/14 (71.4%)	30/36 (83.3%)	32/43 (74.4%)	8/15 (53.3%)	3/4 (75%)	
 12 months	8/10 (80%)	23/26 (88.5%)	33/37 (89.2%)	5/8 (62.5%)	2/2 (100%)	
HR-HPV = high-risk human papillomavirus.

5. Discussion

Currently, the main procedures for HSIL are cervical conization and hysterectomy.[2,3] In this study, we attempted to compare the clearance rate of HR-HPV between 2 surgical procedures (conization vs hysterectomy), and explore the influencing factors. Our results indicated that the postoperative HPV clearance rates were similar between 2 groups (conization vs hysterectomy). This suggests that we also need to concentrate on the postoperative HPV clearance in the 2 groups, either conization or hysterectomy. For the different age groups in total patients, the postoperative HR-HPV clearance rates gradually decreased with the increasing age, indicating that we need to focus on the postoperative HR-HPV status in older population in the 2 groups. To the best of our knowledge, this study is the first to compare the postoperative HPV clearance rates between conization and hysterectomy for HSIL patients.

In terms of preoperative HPV infection, our findings were similar to those reported in the literature. For example, Zhang et al[20] reported that the most common infection was single infection in HSIL patients. Another study found that the most frequent HR-HPV genotypes were HPV16, HPV52, HPV58, HPV33, HPV18, and HPV31 in HSIL patients in northeastern China.[21] Luo et al[22] found that the most prevalent HPV subtypes in HSIL patients were HPV16, HPV52, HPV58, and HPV33 in Chongqing city, China. In this study, the most common infection was single infection, the most common distribution of HR-HPV subtypes of the single infection was HPV16, followed by HPV52, HPV58, HPV33, HPV18, and HPV31.

Concerning the postoperative HPV clearance rate after conization, the current reports do not have consistent results. A study from Korea reported the HPV clearance rates at 6 and 12 months after LEEP to be 85.3% and 93.7%, respectively.[10] Hoffman et al[11] found that the HPV clearance rates at 6 and 12 months after LEEP were 79% and 85%, respectively. Qin et al[12] discovered that the clearance rates at 6 and 12 months after LEEP were 50.5% and 79.2% in HSIL patients. Lu et al[23] indicated that the HPV clearance rates were 81.81% and 85.71% at 6 and 12 months after CKC. Another study reported the HPV clearance rate to be 92.2% at 12 months after CKC.[24] Combined with the retrospective data, we demonstrated that the postoperative HPV clearance rates of conization were 70.6% and 78.6% at 6 and 12 months, respectively.

There are relatively few reports focusing on the postoperative HPV clearance rate after hysterectomy. Cao et al[13] found that the HR-HPV clearance rate after hysterectomy in patients with a CIN history was 81.2% at 12-month follow-up. Egemen et al[14] suggested that the HR-HPV clearance rate after hysterectomy was 82.3% in. In this study, the HPV clearance rates of hysterectomy were 73.8% at the 6-month and 76.5% at the 12-month follows-up respectively, conforming to the previously published study.

For the relationship between HPV infection type and HPV clearance rate, this study has controversial results. Qin et al[12] reported the clearance rate of HPV16/18 to be 1.426 times higher than that of non-HPV16/18, which was also demonstrated in the following study. Moreover, a report from Australia showed that HPV16/18 subtype was cleared faster than other HPV subtypes, regardless of single infection or multiple infections.[25] In addition, a study reported that there was no significant difference in HPV clearance rate between the HPV16/18 infection group and other HR-HPV infection group in HSIL patients after LEEP and conization.[26] In our study, we also found that the clearance rate of HPV16/18 infection was similar to that of non-HPV16/18 infection, and no significant difference was observed.

Concerning the relationship between age and postoperative HPV clearance rate, previous research showed that the older age was associated with a lower HPV clearance rate. For example, an Italian study reported that the HPV clearance rate decreased with age, women aged at least 50 years exhibited the highest level of post-conization HR-HPV genotype, and increasing age was a risk factor for post-conization recurrence, consistent with our study.[27] Another study from China also revealed that lower clearance rates were observed among patients aged at least 50 years.[28] In our study, the clearance rate decreased from 81.8% to 53.6% with the increasing age from 20 to 30 years to 51 to 60 years. Furthermore, we discovered that the HR-HPV clearance rate gradually decreased with the increasing age, suggesting that we need to focus on the elderly population.

Although the mechanism of HPV clearance is unclear, it may be related to the following factors. At first, from the physical perspective, conization removes the precancerous lesion and squamocolumnar transformation zone, which may be the major site of virus infection.[29] Second, regional tissue repair enhances the immunologic function and accelerates the clearance of HPV.[29] Third, conization may increase the number of Lactobacillus bacterial species present after treatments, and the community state type (CST) profiles are shifted from dysbiotic CSTs II and IV to Lactobacillus-dominated CSTs I and III, thereby promoting vaginal microecological balance and improving local immunity to eliminate HPV.[30] Fourth, conization may down-modulate the high expression of programmed death-1 and programmed death-ligand 2, which can thus enhance local immunity of anti-tumor immune response to eliminate HPV and prevent recurrence.[31]

The 2 common treatments of HSIL share the similar HPV clearance rates. However, conization outperforms hysterectomy in terms of the operation time, intraoperative blood loss, and hospitalization expenses. Therefore, for HSIL patients, conization is enough to resect the lesion and eliminate HPV. Moreover, hysterectomy may not improve the outcomes.

However, this study still had the following limitations. Firstly, only data from 1 hospital were used, the sample size was small and there was excessive loss of follow-up due to the retrospective nature. Therefore, more multi-center, prospective randomized clinical trials of HPV-deoxynucleic acid positive combined with HSIL should be planned in the future. Secondly, due to the limited data, we did not compare the clearance rate between LEEP and CKC. In this regard, we will expand the sample size and analyze the HPV clearance rates between the 2 methods in the future study. Thirdly, the follow-up time only included 6 months and 12 months, and thus a long-term follow-up will be continued to compare the clearance rate, and provide evidence for the follow-up arrangement of HSIL patients.

Regardless of the above-mentioned limitations, this study is the first to demonstrate the similar postoperative HPV clearance rates between conization group and hysterectomy group. In addition, the postoperative HR-HPV clearance rate gradually decreases with the increasing age, suggesting that we need to focus on the postoperative HR-HPV status in the older population of the 2 groups.

Author contributions

Conceptualization: Huiquan Hu, Chengzhi Li.

Data curation: Xinglin Liu.

Formal analysis: Xinglin Liu, Chunling Fang, Chang Su.

Investigation: Xinglin Liu.

Methodology: Xinglin Liu, Chunling Fang, Wenhao Hu, Chang Su, Fan Xu.

Project administration: Xinglin Liu.

Resources: Xinglin Liu, Fan Xu, Huiquan Hu.

Software: Chunling Fang, Wenhao Hu, Fan Xu.

Supervision: Chunling Fang, Wenhao Hu.

Visualization: Chunling Fang.

Writing – original draft: Xinglin Liu.

Writing – review & editing: Xinglin Liu, Fan Xu, Chengzhi Li.

Abbreviation:

CIN cervical intraepithelial neoplasia

CKC cold-knife conization

CST community state type

HR-HPV high-risk human papillomavirus

HSIL high-grade squamous intraepithelial lesion

LEEP loop electrosurgical excisional procedure

OR odds ratios

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Nanchong Central Hospital (Protocol number: 2022-009).

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Liu X, Fang C, Hu W, Su C, Xu F, Hu H, Li C. Postoperative clearance of high-risk human papillomavirus for patients with high-grade squamous intraepithelial lesion: Conization versus hysterectomy. Medicine 2024;103:36(e39564).
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