Introduction/Background Long-term persistent infection from high-risk HPV-subtypes is strongly associated with high-grade lesions and cervical cancer due to two overexpressed viral oncoproteins, E6 and E7. Our aim was to detect and evaluate potential alterations in the post-operative status of E6/E7 HPV mRNA in women treated for Cervical Intraepithelial Lesions (CIN) and if so, to evaluate its potential use as a prognostic tool to identify patients with increased risk of treatment failure or recurrent disease.
Methodology Our study retrospectively analyzed 101 women who visited our Colposcopy Clinic with an abnormal Pap smear, or in some cases with histological reports or molecular analysis, suggesting colposcopy. Thin-prep (Hologic) cytological samples were collected before colposcopy and histology (when necessary). After treatment, all women were scheduled for colposcopy and cytology in six months. The cytological material was analyzed with CLART-2 HPV DNA-test (Genomica) and HPV-PROOFER E6/E7 mRNA-test (Pretect).
Results No significant correlations were found for smoking, condom use or vaccination status. It seems that the only statistically significant correlation with actual severity comes from mRNA-test after treatment (ρ=0.261, p=0.008). This probably shows that clinical cases with more severe CIN may have higher chances of unsuccessful treatment. At the first post-op follow-up visit, 83.5% of the HPV-mRNA positive women became negative while only 60.4% of the HPV-DNA positive women became negative. There were 12 HPV-mRNA positive patients both before and after treatment, 3 of were HPV-DNA negative pre- and post-operatively, meaning that if based only on HPV-DNA results, they would have been managed wrongly as successfully-treated patients. Our study shows that E6/E7 mRNA detection has particularly high specificity and positive likelihood ratio for the prediction of treatment failure in comparison with HPV DNA-testing.
Conclusion E6/E7 mRNA overexpression seems to be a promising candidate as an indicator-biomarker to determine the success of treatment and possibly determine the intensity of post-operative monitoring.
Disclosure Nothing to disclose.
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