Genetic, Environmental and Clinical Factors Related to Treatment Failure of Cervical Precancerous Lesions in a Cohort of Brazilian Women.

ABSTRACT

Aims: To ascertain the risk of pre-cancerous treatment failure considering selected genetic, environmental, and clinical characteristics among Brazilian women. Study Design: A prospective study developed in a cohort of women treated for Cervical Intraepithelial Neoplasia (CIN) lesion. Place and Duration of Study Gynecology Oncology day clinic of Brazilian National Cancer Institute, between October 2004 and May 2006. Methodology: We included 285 women (age range 18-75 years) with CIN submitted to lesion excision. All patients were interviewed at admission to identify epidemiological and clinical characteristics, having blood samples collected, and a colposcopic examination performed. TP53 polymorphism was ascertained using PCR-RFLP. After treatment, the study population was followed up with Pap-tests during two years. Treatment failure was evaluated using histological confirmation of any altered tissue. Kaplan-Meyer curves and Cox Proportional Risk Model were used for data analysis. Results: Frequencies of TP53 polymorphisms were Arg72Pro genotype(Arg/Pro)- 177(62.1%); Arg72 genotype(Arg/Arg)-55(19.3%); Pro genotype (Pro/Pro)-53(18.6%). Women with endocervical margins involvement showed an HR 7.01(1.73-28.44). Current smoking was statistically related to CIN treatment failure (HR3.90,95%CI1.28-11.91). Comparatively to Arg/Arg, the risks for treatment failure were HR 1.51(95%CI0.23-9.80) for Arg/Pro women; and HR1.41 (95%CI0.31-6.52) for Pro/Pro. Conclusion: Surgical margins involvement and current tobacco smoking presented independent risks for CIN treatment failure among the studied population. Pro/Pro genotype seems to be associated with CIN treatment failure.