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Showing content from https://pubmed.ncbi.nlm.nih.gov/35470865/ below:

Human papillomavirus vaccination in women undergoing excisional treatment for cervical intraepithelial neoplasia and subsequent risk of recurrence: A systematic review and meta-analysis

Review

Affiliations

• ¹ Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
• ² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
• ³ Department of Gynecology and Obstetrics, NIDO, Center for Research and Education, Gødstrup Hospital, Herning, Denmark.
• ⁴ Department of Obstetrics and Gynecology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
• ⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

• PMID: 35470865
• PMCID: PMC9564558
• DOI: 10.1111/aogs.14359

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Review

Dina Overgaard Eriksen et al. Acta Obstet Gynecol Scand. 2022 Jun.

• ¹ Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
• ² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
• ³ Department of Gynecology and Obstetrics, NIDO, Center for Research and Education, Gødstrup Hospital, Herning, Denmark.
• ⁴ Department of Obstetrics and Gynecology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
• ⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

• PMID: 35470865
• PMCID: PMC9564558
• DOI: 10.1111/aogs.14359

Item in Clipboard

Introduction: In this review and meta-analysis we aimed to investigate whether human papilloma virus (HPV) vaccination administered after excisional treatment of cervical intraepithelial neoplasia (CIN) is associated with a reduced risk of recurrence of CIN grade 2 or worse (CIN2+).

Material and methods: We performed a systematic literature search in three online databases through June 2021. Observational studies and randomized controlled trials (RCTs) were eligible for inclusion if the prophylactic HPV vaccine was administered after excisional treatment for histologically verified CIN. Only English language literature was included. The primary outcome measure was recurrence of CIN2+ after treatment. A meta-analysis was performed using fixed and random-effects models, and results were reported as pooled odds ratios (OR) with 95% confidence intervals (95% CI). Quality assessment was performed using ROB2-tool for RCTs and ROBINS-I for observational studies. The protocol was registered in PROSPERO (CRD42021238257).

Results: A total of 1561 studies were identified, of which nine, including 19 971 women, were included. Two studies were RCTs and seven were observational studies. Using the fixed-effect model on the two RCTs, the OR for recurrence of CIN2+ was 0.29 (95% CI 0.16-0.53). Due to considerable heterogeneity in observational studies, the random-effects model was used to estimate pooled OR for CIN2+ recurrence in these studies. Thus, using unadjusted data from observational studies, the OR for CIN2+ recurrence was 0.35 (95% CI 0.18-0.67), whereas when using adjusted data, the OR for CIN2+ recurrence was 0.54 (95% CI 0.21-1.35). However, quality assessment revealed a serious risk of bias for the majority of the studies included.

Conclusions: HPV vaccination post-treatment was associated with a significantly reduced risk of CIN2+ recurrence when using unadjusted estimates from observational studies and RCTs. We found no significant effect of HPV vaccination on risk of CIN2+ recurrence when using the outcome measure from observational studies with the least risk of bias. Large, well-designed randomized placebo-controlled trials are needed to determine whether post-treatment HPV vaccination should be recommended to all women undergoing excisional treatment for CIN.

Keywords: HPV vaccination; cervical cancer prevention; cervical intraepithelial neoplasia; conization; excisional treatment.

© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

PubMed Disclaimer

PJ and AH have received a speaker's fee from Astra Zeneca, outside the submitted work. AH has received reagents at reduced cost from Roche, Denmark, outside the submitted work. DOE and JBS declare no potential conflict of interest.

PRISMA flowchart summarizing the inclusion…

PRISMA flowchart summarizing the inclusion of papers

PRISMA flowchart summarizing the inclusion of papers

Forest plot of randomized controlled…

Forest plot of randomized controlled trials using the fixed‐effect model. The figure summarizes…

Forest plot of randomized controlled trials using the fixed‐effect model. The figure summarizes odds ratios (OR) of recurrence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) comparing women receiving the HPV vaccine after excisional treatment with women who did not receive the vaccine

Forest plot of observational studies…

Forest plot of observational studies using the random‐effects model on crude estimates (A)…

Forest plot of observational studies using the random‐effects model on crude estimates (A) and adjusted estimates (B). The figure summarizes odds ratios (OR) of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) comparing women receiving the HPV vaccine after excisional treatment with women who did not receive the vaccine

Forest plot of observational studies…

Forest plot of observational studies using the fixed‐effect model on crude estimates (A)…

Forest plot of observational studies using the fixed‐effect model on crude estimates (A) and adjusted estimates (B). The figure summarizes odds ratios (OR) of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) comparing women receiving the HPV vaccine after excisional treatment with women who did not receive the vaccine

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  Petráš M, Dvořák V, Lomozová D, Máčalík R, Neradová S, Dlouhý P, Malinová J, Rosina J, Lesná IK. Petráš M, et al. Sex Transm Infect. 2023 Dec;99(8):561-570. doi: 10.1136/sextrans-2023-055793. Epub 2023 Aug 8. Sex Transm Infect. 2023. PMID: 37553234 Free PMC article.

• Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis.

  Kechagias KS, Kalliala I, Bowden SJ, Athanasiou A, Paraskevaidi M, Paraskevaidis E, Dillner J, Nieminen P, Strander B, Sasieni P, Veroniki AA, Kyrgiou M. Kechagias KS, et al. BMJ. 2022 Aug 3;378:e070135. doi: 10.1136/bmj-2022-070135. BMJ. 2022. PMID: 35922074 Free PMC article.

• Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors.

  Arbyn M, Xu L, Simoens C, Martin-Hirsch PP. Arbyn M, et al. Cochrane Database Syst Rev. 2018 May 9;5(5):CD009069. doi: 10.1002/14651858.CD009069.pub3. Cochrane Database Syst Rev. 2018. PMID: 29740819 Free PMC article. Review.

• The efficacy of human papillomavirus prophylactic vaccination after conization in preventing cervical intraepithelial neoplasia recurrence: A prospective observational study in China.

  Chen M, Li C, Cui Q, Zhou C, Chen P, Yao S. Chen M, et al. Eur J Obstet Gynecol Reprod Biol. 2023 Jul;286:10-15. doi: 10.1016/j.ejogrb.2023.04.014. Epub 2023 Apr 19. Eur J Obstet Gynecol Reprod Biol. 2023. PMID: 37159990

• Prophylactic HPV vaccination after conization: A systematic review and meta-analysis.

  Jentschke M, Kampers J, Becker J, Sibbertsen P, Hillemanns P. Jentschke M, et al. Vaccine. 2020 Sep 22;38(41):6402-6409. doi: 10.1016/j.vaccine.2020.07.055. Epub 2020 Aug 4. Vaccine. 2020. PMID: 32762871 Review.

• Differential Analysis of Pregnancy Outcomes After Treatment of HIFU and LEEP in Patients with Cervical High-Grade Squamous Intraepithelial Lesions.

  Shen XL, Li ZY, Li Q, Wang K. Shen XL, et al. Int J Womens Health. 2024 Jul 29;16:1285-1291. doi: 10.2147/IJWH.S468086. eCollection 2024. Int J Womens Health. 2024. PMID: 39100108 Free PMC article.

• Cervical cancer prevention by vaccination: review.

  González-Rodríguez JC, Cruz-Valdez A, Madrid-Marina V. González-Rodríguez JC, et al. Front Oncol. 2024 Apr 23;14:1386167. doi: 10.3389/fonc.2024.1386167. eCollection 2024. Front Oncol. 2024. PMID: 38715779 Free PMC article. Review.

• Controversies and Advances in the Personalized Surgical Treatment of Cervical Cancer.

  Pergialiotis V, Rodolakis I, Rodolakis A, Thomakos N. Pergialiotis V, et al. J Pers Med. 2024 Jun 6;14(6):606. doi: 10.3390/jpm14060606. J Pers Med. 2024. PMID: 38929827 Free PMC article. Review.

• Effect of Condom Use after CIN Treatment on Cervical HPV Biomarkers Positivity: Prolonged Follow Up Study.

  Valasoulis G, Michail G, Pouliakis A, Androutsopoulos G, Panayiotides IG, Kyrgiou M, Daponte A, Paraskevaidis E. Valasoulis G, et al. Cancers (Basel). 2022 Jul 20;14(14):3530. doi: 10.3390/cancers14143530. Cancers (Basel). 2022. PMID: 35884589 Free PMC article.

• Timing of HPV vaccination as adjuvant treatment of CIN2+ recurrence in women undergoing surgical excision: a meta-analysis and meta-regression.

  Petráš M, Dvořák V, Lomozová D, Máčalík R, Neradová S, Dlouhý P, Malinová J, Rosina J, Lesná IK. Petráš M, et al. Sex Transm Infect. 2023 Dec;99(8):561-570. doi: 10.1136/sextrans-2023-055793. Epub 2023 Aug 8. Sex Transm Infect. 2023. PMID: 37553234 Free PMC article.

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