Serum Lipids, Insulin-Like Growth Factor Binding Protein-3 and Treatment Outcomes in Women with and without Cervical Lesions in South Western Uganda: A Cohort Study

Abstract

Purpose

There is a documented association between cervical cancer and metabolic syndrome. In this study, we determined the association between lipids, insulin-like growth factor binding protein-3 (IGFBP-3) and treatment outcomes for cervical lesions at Mbarara Regional Referral Hospital (MRRH) in south western Uganda.

Patients and Methods

In this prospective cohort study, we recruited 94 cases and 94 controls at the cervical cancer clinic of MRRH, and followed them for 12 months. Cases were confirmed with cytology and/or histology. With consent, we collected demographic data and measured lipids and IGFBP-3 both at baseline and after 12 months. The lipid profile was measured using a Cobas 6000 Chemistry Analyzer, whereas IGFBP-3 was measured using a MAGLUMI fully automated chemiluminescence immunoassay analyzer. Abnormal values for lipids were defined using WHO recommended cut-offs. IGFBP-3 concentrations were divided into two categories of low concentration (<3.29 µg/mL) and raised concentration (≥3.29 µg/mL). Statistical analyses were conducted in STATA version 17 using logistic regression analysis. A p-value of <0.05 was taken to be statistically significant.

Results

The average (mean ± SD) age of our participants was 38.7±8.2 years for controls and 34.5±7.8 years for cases. The average serum IGFBP-3 concentration was 3.769±1.098 µg/mL among cases with cleared lesions and 3.505±0.979 µg/mL among cases whose lesions persisted. A serum IGFBP-3 concentration of less than 3.291 µg/mL was likely to be associated with clearance of cervical lesions (AOR 1.65, p=0.67), although this was not statistically significant. A serum triglyceride concentration of 35–135 mg/dL was also likely to be associated with clearance of cervical lesions (AOR 2.41, p=0.46), although this was also not statistically significant.

Conclusion

Although not statistically significant, reduced serum concentrations of IGFBP-3 and triglyceride may be associated with clearance of cervical lesions. Lipid management may be of benefit in the treatment of cervical lesions.

Keywords:

• cervical intraepithelial neoplasia
• cervical lesions
• clearance
• persistence
• IGFBP-3

Abbreviations

AOR, adjusted odds ratio; ASCUS, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; HPV, human papilloma virus; HSIL, high-grade squamous intraepithelial lesion; IGF-1, insulin-like growth factor-1; IGFBP-3, insulin-like growth factor binding protein-3; IUD, intrauterine device; LDL, low-density lipoprotein; LSIL, low-grade squamous intraepithelial lesion; MRRH, Mbarara Regional Referral Hospital; NILM, negative for intraepithelial lesions or malignancy; Pap, Papanicolaou; SD, standard deviation; STATA, Statistical Software for Data Science; VIA, visual inspection with acetic acid.

Data Sharing Statement

All of the data that informed this article are available from the corresponding author upon reasonable request.

Ethical Considerations

We sought written informed consent from every participant before they took part in the study. We did not use participant names on any data collection tools or laboratory specimens. We did our best to delink all participants’ identifiable information before and during data analysis. All participant interaction with the research team took place in a separate, quiet and comfortable room, free from any disturbances and only accessible to one participant at any single time. This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (MUST-2022-396) as well as the Uganda National Council for Science and Technology (HS2395ES). We also sought administrative clearance from the Hospital Director, Mbarara Regional Referral Hospital. All cases received the standard package of care as offered at the cervical cancer clinic. Participants received their VIA, Pap smear, histology, lipid profile and IGFBP-3 results through the nurses at the clinic. This study complied with the Declaration of Helsinki.

Acknowledgment

We acknowledge the clinical and support staff, research assistants and all patients of the cervical cancer clinic at Mbarara Regional Referral Hospital. The research reported in this publication was supported by the Fogarty International Centre of the National Institutes of Health under Award number D43TW011632. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author Contributions

All authors made a significant contribution to the work reported in this paper, including conception of the idea, study design, execution, acquisition of data, data analysis and interpretation, in any or all of these areas; and took part in drafting, revising or critically reviewing the article. All authors gave final approval of the final version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.