HPV 疫苗接种与浸润性宫颈癌风险。

HPV Vaccination and the Risk of Invasive Cervical Cancer.

机构信息

From the Departments of Medical Epidemiology and Biostatistics (J.L., A.P., P.S.) and Laboratory Medicine (K.M.E., J.W., K.S., J.D.) and the Institute of Environmental Medicine (F.F.), Karolinska Institutet, the Regional Cancer Center Stockholm Gotland (K.M.E.), and the Karolinska University Laboratory, Karolinska University Hospital (J.D.), Stockholm, the Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Solna (A.R.), and the Department of Translational Medicine, Lund University, Lund (A.R.) - all in Sweden.

出版信息

N Engl J Med. 2020 Oct 1;383(14):1340-1348. doi: 10.1056/NEJMoa1917338.

DOI:10.1056/NEJMoa1917338

PMID:32997908

Abstract

BACKGROUND

The efficacy and effectiveness of the quadrivalent human papillomavirus (HPV) vaccine in preventing high-grade cervical lesions have been shown. However, data to inform the relationship between quadrivalent HPV vaccination and the subsequent risk of invasive cervical cancer are lacking.

METHODS

We used nationwide Swedish demographic and health registers to follow an open population of 1,672,983 girls and women who were 10 to 30 years of age from 2006 through 2017. We assessed the association between HPV vaccination and the risk of invasive cervical cancer, controlling for age at follow-up, calendar year, county of residence, and parental characteristics, including education, household income, mother's country of birth, and maternal disease history.

RESULTS

During the study period, we evaluated girls and women for cervical cancer until their 31st birthday. Cervical cancer was diagnosed in 19 women who had received the quadrivalent HPV vaccine and in 538 women who had not received the vaccine. The cumulative incidence of cervical cancer was 47 cases per 100,000 persons among women who had been vaccinated and 94 cases per 100,000 persons among those who had not been vaccinated. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% confidence interval [CI], 0.32 to 0.82). After additional adjustment for other covariates, the incidence rate ratio was 0.37 (95% CI, 0.21 to 0.57). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI, 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI, 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years.

CONCLUSIONS

Among Swedish girls and women 10 to 30 years old, quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level. (Funded by the Swedish Foundation for Strategic Research and others.).

摘要

背景

四价人乳头瘤病毒（HPV）疫苗在预防高级别宫颈病变方面的有效性已得到证实。然而，尚无数据表明四价 HPV 疫苗接种与随后的浸润性宫颈癌风险之间存在关系。

方法

我们利用全国性的瑞典人口统计学和健康登记处，对 2006 年至 2017 年间年龄在 10 至 30 岁的 1672983 名女性进行了开放性人群随访。我们评估了 HPV 疫苗接种与浸润性宫颈癌风险之间的关联，同时控制了随访时的年龄、日历年份、居住地县以及包括教育、家庭收入、母亲出生地和母亲病史在内的父母特征。

结果

在研究期间，我们对女孩和女性进行了宫颈癌评估，直至她们 31 岁生日。在接受四价 HPV 疫苗接种的 19 名女性和未接种疫苗的 538 名女性中，诊断出了宫颈癌。接种疫苗的女性中宫颈癌的累积发病率为每 100000 人 47 例，而未接种疫苗的女性中为每 100000 人 94 例。在调整了随访时的年龄后，接种人群与未接种人群的发病率比为 0.51（95%置信区间[CI]，0.32 至 0.82）。在进一步调整其他协变量后，发病率比为 0.37（95%CI，0.21 至 0.57）。在调整了所有协变量后，17 岁以下接种疫苗的女性发病率比为 0.12（95%CI，0.00 至 0.34），17 至 30 岁接种疫苗的女性发病率比为 0.47（95%CI，0.27 至 0.75）。