Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Osaka, Japan.
Cancer Sci. 2021 Feb;112(2):839-846. doi: 10.1111/cas.14682. Epub 2020 Dec 11.
Cervical cancer remains among the most common cancers in women worldwide and can be prevented by vaccination. The Ministry of Health, Labour and Welfare of Japan suspended active recommendation of regular human papillomavirus (HPV) vaccines in 2013 because of various symptoms including chronic pain and motor impairment. This nationwide case-control study from April 2013 to March 2017 targeted women aged 20-24 years old at cervical screening. We compared HPV vaccination exposure between those with abnormal and normal cytology. Abnormal cytology was classified based on the results of histological test and we calculated the odds ratio (OR) and 95% confidence interval (CI) of the above endpoints and vaccination exposure using the conditional logistic regression model and estimated vaccine effectiveness using the formula (1 - OR) × 100. A total of 2483 cases and 12 296 controls (one-to-five matching) were eligible in 31 municipalities in Japan. The distribution of histological abnormalities among cases was 797 CIN1 (including dysplasia) (32.1%), 165 CIN2 (6.7%), 44 CIN3 (1.8%), and eight squamous cell carcinoma (SCC) (0.3%). The OR of HPV vaccination compared with no vaccination for abnormal cytology, CIN1+, CIN2+, and CIN3+ versus controls was 0.42 (95% CI, 0.34-0.50), 0.42 (95% CI, 0.31-0.58), 0.25 (95% CI, 0.12-0.54), and 0.19 (95% CI, 0.03-1.15), respectively, equating to a vaccine effectiveness of 58.5%, 57.9%, 74.8%, and 80.9%, respectively. Eight patients had SCC, none was vaccinated. This nationwide case-control study in Japan demonstrated a substantial risk reduction in abnormal cytology and CIN among women who did versus those who did not receive HPV vaccination.
宫颈癌仍然是全球女性最常见的癌症之一，可以通过接种疫苗来预防。日本厚生劳动省于 2013 年因各种症状（包括慢性疼痛和运动障碍）暂停了对常规人乳头瘤病毒（HPV）疫苗的积极推荐。这项从 2013 年 4 月至 2017 年 3 月进行的全国性病例对照研究以接受宫颈癌筛查的 20-24 岁女性为研究对象。我们比较了细胞学异常和正常的女性中 HPV 疫苗的接种情况。细胞学异常根据组织学检查结果进行分类，我们使用条件逻辑回归模型计算了上述终点和疫苗接种暴露的比值比（OR）和 95%置信区间（CI），并使用公式（1-OR）×100 估计疫苗效力。在日本 31 个市共纳入 2483 例病例和 12296 例对照（1:5 匹配）。病例中组织学异常的分布为 797 例 CIN1（包括发育不良）（32.1%）、165 例 CIN2（6.7%）、44 例 CIN3（1.8%）和 8 例鳞状细胞癌（SCC）（0.3%）。HPV 疫苗接种与未接种相比，细胞学异常、CIN1+、CIN2+和 CIN3+的 OR 分别为 0.42（95%CI，0.34-0.50）、0.42（95%CI，0.31-0.58）、0.25（95%CI，0.12-0.54）和 0.19（95%CI，0.03-1.15），疫苗效力分别为 58.5%、57.9%、74.8%和 80.9%。8 例患者患有 SCC，均未接种疫苗。这项在日本进行的全国性病例对照研究表明，与未接种 HPV 疫苗的女性相比，接种疫苗的女性细胞学异常和 CIN 的风险显著降低。
