title: Interaction of epithelial biomarkers, local immune response and condom use in cervical intraepithelial neoplasia 2-3 regression.
abstract: OBJECTIVE
  Cervical intraepithelial neoplasia grades 2-3 (CIN2-3) are usually treated by cone excision, although only 30% progress to cancer and 6-50% regress spontaneously. Biomarkers predicting CIN2-3 regression would be of great clinical value and could reduce unnecessary cone excision and associated complications. The aim of this study was to investigate whether punch-biopsy derived immunohistochemical biomarkers, local immune response, CIN lesion size and condom use are independently correlated to regression of CIN2-3.
  
  
  METHODS
  A prospective population-based cohort study of 162 women aged 25-40, with first-time onset diagnosis of CIN2-3 in colposcopy-directed biopsies was carried out. The median biopsy-cone interval was 16 weeks. Regression was defined as CIN1 or less in the cone biopsy.
  
  
  RESULTS
  The regression rate was 21% (34/162). pRb>30% in the lower epithelial half was the strongest predictor for regression (30% regression, p<0.0001). If additionally a CIN-lesion was smaller than 2.5mm and CD4+ lymphoid cells in the subepithelial stroma ≤ 195 per 1.04 mm basal membrane, the regression rate was 53%. In CIN-lesions>2.5mm and CD4+-stroma ≤195, consistent condom use increased the regression rate from 13% to 67% (p=0.003). If pRb was ≤30%, the regression rate was low (6%).
  
  
  CONCLUSIONS
  Biomarkers and CIN lesion length can predict CIN2-3 regression, and might be helpful to identify patients who can increase the regression rate of CIN lesions by consistent condom use.
authors.affiliation: Department of Gynecology and Obstetrics, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Ane Cecilie
authors.initials: AC
authors.lastname: Munk
authors.forename: Einar
authors.initials: E
authors.lastname: Gudlaugsson
authors.forename: Irene Tveiteras
authors.initials: IT
authors.lastname: Ovestad
authors.forename: Kjell
authors.initials: K
authors.lastname: Lovslett
authors.forename: Bent
authors.initials: B
authors.lastname: Fiane
authors.forename: Bianca van Diermen
authors.initials: Bv
authors.lastname: Hidle
authors.forename: Arnold-Jan
authors.initials: AJ
authors.lastname: Kruse
authors.forename: Ivar
authors.initials: I
authors.lastname: Skaland
authors.forename: Emiel A M
authors.initials: EA
authors.lastname: Janssen
authors.forename: Jan P A
authors.initials: JP
authors.lastname: Baak
mesh_terms: D000328:Adult; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D017280:Condoms; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000276:immunology / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000276:immunology / Q000473:pathology* / Q000821:virology
chemical_list: D015415:Biomarkers