Prophylactic HPV vaccination after conization

A systematic review and meta-analysis

authored by

M. Jentschke, J. Kampers, Jürgen Becker, Philipp Sibbertsen, P. Hillemanns

Abstract

Introduction: Human papillomavirus (HPV) vaccination is essential for cervical cancer prevention. However, the value of HPV vaccination in the context excisional treatment of high-grade cervical intraepithelial neoplasia (CIN 3) remains unclear. Methods: In this meta-analysis, three retrospective and three prospective studies, three post-hoc analyses of RCTs and one cancer registry study analysing the effect of pre- or post-conization vaccination (bi- or quadrivalent vaccine) against HPV were included after a systematic review of literature. Random-effect models were prepared to evaluate the influence of vaccination on recurrent CIN 2+. Results: Primary end point was CIN2+ in every study. The overall study population included 21,059 patients (3,939 vaccinations vs. 17,150 controls). The results showed a significant risk reduction for the development of new high-grade intraepithelial lesions after HPV vaccination (relative risk (RR) 0.41; 95% CI [0.27; 0.64]), independent from HPV type. Due to the heterogeneous study population multiple sub analyses regarding HPV type, age of patients, time of vaccination and follow-up were performed. Age-dependent analysis showed no differences between women under 25 years (RR 0.47 (95%-CI [0.28; 0.80]) and women of higher age (RR 0.52 (95%-CI [0.41; 0.65]). Results for HPV 16/18 positive CIN2+ showed a RR of 0.37 (95% CI [0.17; 0.80]). Overall, the number of women that would have to be vaccinated before or after conization to prevent one case of recurrent CIN 2+ (NNV) is 45.5. Conclusion: Meta-analysis showed a significant risk reduction of developing recurrent cervical intraepithelial neoplasia after surgical excision and HPV vaccination compared to surgical excision only.

Organisation(s)

Institute of Statistics

External Organisation(s)

Hannover Medical School (MHH)

Type

Review article

Journal

Vaccine

Volume

38

Pages

6402-6409

No. of pages

8

ISSN

0264-410X

Publication date

22.09.2020

Publication status

Published

Peer reviewed

Yes

ASJC Scopus subject areas

Molecular Medicine, Immunology and Microbiology(all), veterinary(all), Public Health, Environmental and Occupational Health, Infectious Diseases

Sustainable Development Goals

SDG 3 - Good Health and Well-being

Electronic version(s)

https://doi.org/10.1016/j.vaccine.2020.07.055 (Access: Closed)