Bogani Giorgio, Raspagliesi Francesco, Sopracordevole Francesco, Ciavattini Andrea, Ghelardi Alessandro, Simoncini Tommaso, Petrillo Marco, Plotti Francesco, Lopez Salvatore, Casarin Jvan, Serati Maurizio, Pinelli Ciro, Valenti Gaetano, Bergamini Alice, Gardella Barbara, Dell'Acqua Andrea, Monti Ermelinda, Vercellini Paolo, D'ippolito Giovanni, Aguzzoli Lorenzo, Mandato Vincenzo D, Carunchio Paola, Carlifante Gabriele, Gianella Luca, Scaffa Cono, Falcone Francesca, Ferla Stefano, Borghi Chiara, Ditto Antonino, Malzoni Mario, Giannini Andrea, Salerno Maria Giovanna, Liberale Viola, Contino Biagio, Donfrancesco Cristina, Desiato Michele, Perrone Anna Myriam, Dondi Giulia, De Iaco Pierandrea, Leone Roberti Maggiore Umberto, Signorelli Mauro, Chiappa Valentina, Ferrero Simone, Sarpietro Giuseppe, Matarazzo Maria G, Cianci Antonio, Bocio Sara, Ruisi Simona, Guerrisi Rocco, Brusadelli Claudia, Mosca Lavinia, Tinelli Raffaele, De Vincenzo Rosa, Zannoni Gian Franco, Ferrandina Gabriella, Dessole Salvatore, Angioli Roberto, Greggi Stefano, Spinillo Arsenio, Ghezzi Fabio, Colacurci Nicola, Fischetti Margherita, Carlea Annunziata, Zullo Fulvio, Muzii Ludovico, Scambia Giovanni, Benedetti Panici Pierluigi, Di Donato Violante
Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy.
Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, Via F. Gallini 2, 33081 Aviano, Italy.
Vaccines (Basel). 2020 Dec 1;8(4):717. doi: 10.3390/vaccines8040717.
: 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. 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. : 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% ( = 2) and 5.7% ( = 102) after conization plus vaccination and conization alone, respectively ( = 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 ( = 0.231). Vaccination had no impact on persistent lesions (no negative examination between conization and new cervical dysplasia; = 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; = 0.031). 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.
通过接种疫苗进行一级预防是一种预防性方法，旨在降低发生人乳头瘤病毒（HPV）相关病变的风险。尚无成熟的长期数据支持对接受锥切术的女性采用接种疫苗的方式。这是一项回顾性多机构研究。收集了2010年至2014年间连续接受锥切术患者的病历。纳入的所有患者均至少随访5年。我们比较了接受锥切术加接种疫苗和单纯接受锥切术患者的结局。应用倾向评分匹配算法以减少分配偏倚。使用Kaplan-Meir和Cox风险模型估计复发风险。总体而言，分析了1914名女性的病历。研究组分别包括116名（6.1%）接受锥切术加接种疫苗的女性和1798名（93.9%）单纯接受锥切术的女性。锥切术加接种疫苗和单纯锥切术后的五年复发率分别为1.7%（n = 2）和5.7%（n = 102）（P = 0.068）。应用倾向评分匹配后，我们选择了100名接受锥切术加接种疫苗的患者和200名单纯接受锥切术的患者。接受锥切术加接种疫苗和单纯锥切术的患者复发的原始例数分别为2例（2%）和11例（5.5%）（P = 0.23）。接种疫苗对持续性病变无影响（锥切术与新的宫颈发育异常之间检查结果无阴性；P = 0.603），但降低了复发疾病的风险（锥切术与复发性宫颈发育异常诊断之间至少有一次检查结果为阴性的患者；P = 0.031）。有接种疫苗经历的患者复发风险略低于未接种疫苗的女性，尽管差异无统计学意义。需要进一步的证据来评估在这种情况下采用接种疫苗的成本效益。
