title: Natural Antibodies to Human Papillomavirus 16 and Recurrence of Vulvar High-Grade Intraepithelial Neoplasia (VIN3).
abstract: OBJECTIVE
  Approximately 30% of women treated for squamous high-grade intraepithelial neoplasia (VIN3), often associated with human papillomavirus (HPV), have recurrent disease. In this study, we assess predictors of recurrence that may provide targets for early prevention or treatment.
  
  
  METHODS
  Women with VIN3 who participated in a previous population-based case-control study with blood and tumor samples completed a follow-up telephone interview an average of 5 years after initial diagnosis. The risk of recurrence was determined by proportional hazards modeling.
  
  
  RESULTS
  Women with VIN3 in the follow-up study (n = 65) were similar to women with VIN3 in the parent study (n = 215) with regard to age at primary diagnosis, level of current cigarette smoking (>60%), and lifetime number of partners. We found that 22 (33.8%) of 65 participants had a vulvar recurrence and that 73.4% recurred within 3 years of treatment. Recurrences occurred more often among women with common warts in the decade before diagnosis (hazard ratio [HR] = 2.5, 95% CI = 1.1-5.8) and among those with a previous anogenital cancer (HR = 2.7, 95% CI = 1.2-6.3). Interestingly, recurrence was less frequent among women who mounted a natural antibody response to HPV16 (HR = 0.4, 95% CI = 0.2-0.9).
  
  
  CONCLUSIONS
  These data provide strong preliminary evidence that VIN3 recurrence was less frequent among those with HPV16 antibodies. Vaccination with the currently licensed HPV vaccine as part of adjunctive therapy for VIN3 would increase antibody response and may decrease risk of recurrence. Randomized controlled trials are needed to determine whether HPV vaccination is effective against VIN3 recurrence.
authors.affiliation: 1Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA; 2Department of Epidemiology, University of Washington, Seattle, WA; 3Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA; and 4Department of Microbiology, University of Washington, Seattle, WA.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Madeleine
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Johnson
authors.forename: David R
authors.initials: DR
authors.lastname: Doody
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Tipton
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Carter
authors.forename: Denise A
authors.initials: DA
authors.lastname: Galloway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D052162:Human papillomavirus 16 / Q000276:immunology*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000276:immunology*; D012008:Recurrence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
chemical_list: D000914:Antibodies, Viral