title: Scoring system and management algorithm assessing the role of survivin expression in predicting progressivity of HPV infections in precancerous cervical lesions.
abstract: BACKGROUND
  To identify the risk factors and assess the role of survivin in predicting progessivity precancerous cervical lesions.
  
  
  METHODS
  This case-control study was conducted from October 2009 until May 2010. We obtained 74 samples, classified according to the degree of cervical intraepithelial neoplasia (CIN): 19 samples for CIN 1, 18 samples for CIN 2, 18 samples for CIN 3, and 19 samples as controls. Demographic profiles and risk factors assesment, histopathologic examination, HPV DNA tests, immunocytochemistry (ICC) and immunohistochemistry (IHC) staining for survivin expression were performed on all samples. Data was analyzed with bivariate and multivariate analysis.
  
  
  RESULTS
  Multivariate analysis revealed significant risk factors for developing precancerous cervical lesions are age <41 years, women with ≥2 sexual partners, course of education ≥13 years, use of oral contraceptives, positive high-risk HPV DNA, and high survivin expression by ICC or IHC staining. These factors were fit to a prediction model and we obtained a scoring system to predict the progressivity of CIN lesions.
  
  
  CONCLUSIONS
  Determination of survivin expression by immunocytochemistry staining, along with other significant risk factors, can be used in a scoring system to predict the progressivity of CIN lesions. Application of this scoring system may be beneficial in determining the action of therapy towards the patient.
authors.affiliation: Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. junita.indarti@gmail.com
authors.forename: Junita
authors.initials: J
authors.lastname: Indarti
authors.forename: M Farid
authors.initials: MF
authors.lastname: Aziz
authors.forename: Bethy
authors.initials: B
authors.lastname: Suryawati
authors.forename: Darrell
authors.initials: D
authors.lastname: Fernando
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000378:metabolism*; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism*; D008875:Middle Aged; D060787:Neoplasm Grading; D027383:Papillomaviridae / Q000502:physiology; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D011230:Precancerous Conditions; D011379:Prognosis; D012307:Risk Factors; D000077022:Survivin; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000378:metabolism / Q000821:virology
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin