p16^INK4a Expression does not predict the outcome of cervical intraepithelial neoplasia grade 2

Authors: GUEDES¹; BRENNA; COELHO²; MARTINEZ³; SYRJÄNEN⁴; ZEFERINO⁵

Source: International Journal of Gynecological Cancer, Volume 17, Number 5, September/October 2007 , pp. 1099-1103(5)

Publisher: Wiley-Blackwell

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Abstract:

Guedes AC, Brenna SMF, Coelho SAS, Martinez EZ, Syrjänen KJ, Zeferino LC. p16^INK4a expression does not predict the outcome of cervical intraepithelial neoplasia grade 2. Int J Gynecol Cancer 2007;17:1099-1103.

Spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN2) lesions has been recognized since 1955, but predictors of this are poorly understood. Among the predictive markers studied, p16^INK4a has been suggested to be of some value in monitoring the diagnosis of CIN2. In this clinical trial, 90 Brazilian women, diagnosed to CIN2 and high-risk human papillomavirus infection, were randomized into two groups of equal size: 45 women whose lesions were excised and 45 women subjected to prospective follow-up at 3-month intervals at least for 1 year (mean 6.8 months). p16^INK4a expression was analyzed in paraffin-embedded sections using immunohistochemical staining. Among the 45 women in the follow-up group, 42% experienced spontaneous regression, 11% showed persistence, 22% progressed to CIN3, and 20% had partial regression to CIN1 or ASCUS (atypical squamous cell undetermined signifiance). p16^INK4a expression was detected in 68.9% of the patients. In univariate survival (Cox) analysis, no significant difference in regression was obtained between p16^INK4a-negative and -positive CIN2 lesions (adjusted HR = 1.1; 95% CI 0.6-2.0). In conclusion, p16^INK4a expression could be useful in the diagnosis of CIN2. However, it failed to predict the outcome of CIN2. Because of its high spontaneous regression rate, follow-up could be considered as a management option of CIN2 in young and compliant women.

Keywords: cervical intraepithelial neoplasia; CIN2; natural history; p16INK4a; regression

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1525-1438.2007.00899.x

Affiliations: 1: Department of Gynecology, Leonor Mendes de Barros Maternity Hospital, Health State Secretariat, São Paulo, Brazil 2: Department of Pathology, Universidade de São Paulo, São Paulo, Brazil 3: Department of Social Medicine, Medical School of Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil 4: Department of Oncology and Radiotherapy, Turku University Central Hospital, Turku, Finland 5: Department of Gynecology and Obstetrics, The School of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil

Publication date: 2007-09-01