Page 116 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 6
Abstract
Background: The majority of Cervical Intraepithelial Neoplasia (CIN) 2 lesions will regress without treatment. Conservative management is often advised, but the natural history of an individual lesion remains unpredictable. Identification of prognostic factors in CIN2 lesions would enable a more individualized patient counseling with regard to management options. Since the implementation of HPV-based screening for cervical cancer, the majority of CIN2 lesions is high- risk (hr)HPV positive. Evidence on prognostic factors in hrHPV-positive CIN2 is lacking.
Objective: The aim of this study is to identify prognostic factors for the spontaneous regression of exclusively high-risk HPV positive CIN2.
Study design: This registration-based retrospective cohort study was conducted at the Maastricht University Medical Center, Maastricht, the Netherlands. Women with a hrHPV positive CIN2 lesion who received observational management (including cytological follow-up) between January 1, 2000, and April 30, 2013 were included. Regression was defined as PAP 1/2 cytology or ≤CIN 1 histology at the 24-month follow-up and no diagnosis of ≥CIN 2 before the 24-month follow-up visit. Potential prognostic factors (HPV16/18, p16 staining, KI67 staining, age, smoking status, last PAP smear result, multiple CIN2 lesions, oral contraception use and parity) were assessed using logistic regression analysis.
Results: 56 women were included in the study, of which 34 (61%) showed spontaneous regression of their lesion. Not smoking and nulliparity were identified as significant prognostic factors for disease regression (OR 3.84 [1.04-14.21] and OR 5.00 [1.32-19.00], respectively).
Conclusions: Smoking status and parity influence the likelihood of disease regression in hrHPV positive CIN2. These factors should be considered in individual patient counseling regarding the choice between immediate treatment or conservative management.
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