Page 122 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 6
Table 2. Results of logistic regression analysis of potential predictors for spontaneous regression of hrHPV positive CIN2
Univariable analysis
Multivariable analysis, correction for age
Multivariable analysis, correction for HPV 16/18 negative
Predictor
Age
HPV 16/18 negative
Weak p16 staining
Weak KI67 staining
Not smoking at time of diagnosis
No more than one CIN2 lesion
No use of oral con- traception at time of diagnosis
Nulliparity at time of diagnosis
* significant
Discussion
OR [95%CI]
1.00 [0.95-1.06] 0.98 [0.31-3.08] 1.05 [0.34-3.20] 0.82 [0.24-2.80] 3.84 [1.04-14.21]
2.53 [0.39-16.51] 0.50 [0.16-1.62]
5.00 [1.32-19.00]
p value
0.95 0.97 0.94 0.75 0.04*
0.33 0.25
0.02*
OR [95%CI]
-
0.97 [0.31-3.09]
1.05 [0.34-3.20] 0.94 0.78 [0.21-2.96] 0.71 3.84 [1.04-14.24] 0.04*
2.61 [0.38-17.85] 0.33 0.49 [0.15-1.60] 0.24
9.82 [1.75-55.04] 0.01*
p value OR [95%CI]
p value
0.95 - 0.93 0.74 0.04*
0.32 0.25
0.02*
- 1.03 [0.32-3.24] 0.96 -
1.05 [0.34-3.21] 0.81 [0.23-2.85] 3.84 [1.03-14.33]
2.64 [0.39-17.95] 0.50 [0.15-1.63]
5.00 [1.32-19.00]
In this study, we identified smoking status and nulliparity as prognostic factors in the natural history of hrHPV positive CIN2. No significant effect was found for HPV16/18, p16 staining, KI67 staining, age, last PAP smear result, multiple CIN2 lesions and oral contraception as potential prognostic factors.
To the best of our knowledge, this is the first study to assess potential predictors of spontaneous regression in exclusively hrHPV positive CIN2 lesions. Previous studies that assessed prognostic markers in exclusively CIN2 lesions included either a mixed population of both hrHPV positive and negative women or a population with unknown HPV status.[4, 14-16] We hypothesized that the effect of potential predictors may be different in a population of exclusively high-grade HPV positive CIN2, due to a prognostic effect of hrHPV itself. Indeed, hrHPV genotypes were found to predict an increased disease progression and a decreased disease regression in several studies in high-grade CIN lesions.[13] As such, a population of exclusively hrHPV positive CIN2 lesions reflects a more ‘high-risk’ population than a population that also includes hrHPV negative lesions, which may influence potential prognostic factors in the two populations. Indeed, our study results were different from previous studies in CIN2 lesions. The previous studies on prognostic factors in hrHPV positive and negative CIN2 lesions identified various prognostic markers, although findings were not always consistent. Non-consistent results among the different studies were found for age, lesions size, oral contraception use and p-16 staining.[4, 14-16] Furthermore sexarche and parity were each evaluated in one study and were both found
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