title: Matrix metalloproteinase-2 (MMP-2) and its tissue inhibitor (TIMP-2) are prognostic factors in cervical cancer, related to invasive disease but not to high-risk human papillomavirus (HPV) or virus persistence after treatment of CIN.
abstract: OBJECTIVE
  Matrix metalloproteinase-2 (MMP-2) and its tissue inhibitor (TIMP-2) are important regulators of cancer invasion and metastasis. Their associations to high-risk (HR) human papillomavirus (HPV) in cervical intra-epithelial neoplasia (CIN) and cervical cancer (CC) are unexplored and their prognostic significance in CC remains controversial.
  
  
  METHODS
  As part of our HPV-PathogenISS study, a series of 150 CCs and 152 CIN lesions were examined using immunohistochemical (IHC) staining for MMP-2 and TIMP-2 and tested for HPV using PCR with 3 primer sets (MY09/11, GP5+/GP6+, SPF). Follow-up data were available from all squamous cell carcinoma patients and 67 CIN lesions had been monitored with serial PCR for HPV after cone treatment.
  
  
  RESULTS
  MMP-2 increased with the grade of CIN, with major up-regulation upon transition to invasive cancer (OR 20.78) (95%CI 7.16-60.23) (p=0.0001). TIMP-2 retained its normal expression until CIN3, with dramatic down-regulation in invasive disease (p=0.0001 for trend). Thus, the MMP2:TIMP-2 ratio increased with progressive CIN, exceeding the value 1.0 only in invasive disease. Both MMP-2 and TIMP-2 are highly specific (TIMP-2; 100%) discriminators of CIN with 100% positive predictive value (TIMP-2), but suffer from low sensitivity and negative predictive value. Neither MMP-2 nor TIMP-2 showed any significant association with HR HPV or virus persistence/clearance. TIMP-2 (but not MMP-2) was a significant predictor of survival in univariate (Kaplan-Meier) analysis (p=0.007), but lost its significance in multivariate (Cox) analysis.
  
  
  CONCLUSIONS
  The activities of MMP-2 and TIMP-2 in cervical carcinogenesis seem to be unrelated to HR-HPV The inverse MMP-2:TIMP-2 ratio is a sign of poor prognosis. A combination of a TIMP-2 assay with another test showing high SE and high NPV (e.g., HCII for HPV) should provide a potential screening tool capable of accurate detection of CIN.
authors.affiliation: Unità Citoistopatologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Rome.
authors.forename: M
authors.initials: M
authors.lastname: Branca
authors.forename: M
authors.initials: M
authors.lastname: Ciotti
authors.forename: C
authors.initials: C
authors.lastname: Giorgi
authors.forename: D
authors.initials: D
authors.lastname: Santini
authors.forename: L
authors.initials: L
authors.lastname: Di Bonito
authors.forename: S
authors.initials: S
authors.lastname: Costa
authors.forename: A
authors.initials: A
authors.lastname: Benedetto
authors.forename: D
authors.initials: D
authors.lastname: Bonifacio
authors.forename: P
authors.initials: P
authors.lastname: Di Bonito
authors.forename: P
authors.initials: P
authors.lastname: Paba
authors.forename: L
authors.initials: L
authors.lastname: Accardi
authors.forename: S
authors.initials: S
authors.lastname: Syrjänen
authors.forename: C
authors.initials: C
authors.lastname: Favalli
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000201:enzymology / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020778:Matrix Metalloproteinase 2 / Q000096:biosynthesis*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000201:enzymology / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000096:biosynthesis*; D002583:Uterine Cervical Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000201:enzymology* / Q000473:pathology / Q000821:virology*
chemical_list: D019716:Tissue Inhibitor of Metalloproteinase-2; D020778:Matrix Metalloproteinase 2