Assessing the Long-Term Role of Vaccination against HPV after Loop Electrosurgical Excision Procedure (LEEP): A Propensity-Score Matched Comparison

Abstract

Background: Primary prevention through vaccination is a prophylactic approach aiming to reduce the risk of developing human papillomavirus (HPV)-related lesions. No mature and long-term data supported the adoption of vaccination in women undergoing conization. Methods: This is a retrospective multi-institutional study. Charts of consecutive patients undergoing conization between 2010 and 2014 were collected. All patients included had at least 5 years of follow-up. We compared outcomes of patients undergoing conization plus vaccination and conization alone. A propensity-score matching algorithm was applied in order to reduce allocation biases. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, charts of 1914 women were analyzed. The study group included 116 (6.1%) and 1798 (93.9%) women undergoing conization plus vaccination and conization alone, respectively. Five-year recurrence rate was 1.7% (n = 2) and 5.7% (n = 102) after conization plus vaccination and conization alone, respectively (p = 0.068). After the application of a propensity-score matching, we selected 100 patients undergoing conization plus vaccination and 200 patients undergoing conization alone. The crude number of recurrences was 2 (2%) and 11 (5.5%) for patients undergoing conization plus vaccination and conization alone, respectively (p = 0.231). Vaccination had no impact on persistent lesions (no negative examination between conization and new cervical dysplasia; p = 0.603), but reduced the risk of recurrent disease (patients who had at least one negative examination between conization and the diagnosis of recurrent cervical dysplasia; p = 0.031). Conclusions: Patients having vaccination experience a slightly lower risk of recurrence than women who had not, although not statistically significantly different. Further evidence is needed to assess the cost effectiveness of adopting vaccination in this setting.

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

“…Of these studies, 39 were excluded, according to our inclusion/exclusion criteria, as they evaluated other therapies than conization/LEEP or provided no adjuvant HPV vaccination. Eleven studies fulfilled the predefined inclusion criteria and were eligible for inclusion in the final meta-analysis [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. In total, the studies comprised 21,310 patients: 4039 (19%) received adjuvant HPV vaccination while 17,271 (81%) surgery alone.…”

“…All studies were published between 2012 and 2020. The study designs included: three prospective non-randomized studies [ 41 , 44 , 46 ], one randomized controlled trial [ 42 ], four retrospective studies [ 38 , 43 , 45 , 47 ], and three post-hoc pooled analyses of randomized clinical trials [ 37 , 39 , 40 ]. The women included in the studies were between the years of 15 and 89.…”

“…The median follow-up time across the studies ranged from 2 to 5 years. HPV vaccination was administered after surgical treatment in nine studies [ 37 , 38 , 39 , 40 , 41 , 42 , 45 , 46 , 47 ], while either shortly before or after surgery in the other two studies [ 43 , 44 ]. The type of vaccine used was quadrivalent (against HPV 6/11/16/18 genotypes) in four studies [ 37 , 38 , 41 , 42 ] and bivalent (against HPV 16/18 genotypes) in two [ 39 , 40 ], whereas the other five studies [ 43 , 44 , 45 , 46 , 47 ] used both vaccines.…”

Surgical Treatment of Vulvar HSIL: Adjuvant HPV Vaccine Reduces Recurrent Disease

“…In order to reduce disease relapse, adjuvant vaccination in HPV related disease is an upcoming issue [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]; this clinical topic is analysed by a very recent review investigating about the use of prophylactic vaccines in patients treated for HPV related pathologies [ 37 ].…”

A Placebo-Controlled, Double-Blind Randomized (Phase IIB) Trial of Oral Administration with HPV16 E7-Expressing Lactobacillus, GLBL101c, for the Treatment of Cervical Intraepithelial Neoplasia Grade 2 (CIN2)

“…Hysterectomy leads to infertility, and conization of the cervix worsens obstetrical outcomes in subsequent pregnancies. Therefore, conization is considered as a standard surgical treatment of CIN2-3 especially for patients who is willing to preserve their fertility; however, the risk of preterm birth and the rate of cesarean delivery and low birth weight are approximately three times higher after conization [ 5 , 6 , 7 ]. Because the age at which CIN2-3 develops coincides with the age at which a woman becomes pregnant and gives birth, the worsening of obstetrical outcomes because of cervical incompetence after partial resection of the cervix is the major issue for reproductive health of young women.…”