辅助性人乳头瘤病毒疫苗预防手术治疗后复发性宫颈发育异常：一项荟萃分析。

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

作者信息

Di Donato Violante, Caruso Giuseppe, Petrillo Marco, Kontopantelis Evangelos, Palaia Innocenza, Perniola Giorgia, Plotti Francesco, Angioli Roberto, Muzii Ludovico, Benedetti Panici Pierluigi, Bogani Giorgio

机构信息

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy.

Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy.

出版信息

Vaccines (Basel). 2021 Apr 21;9(5):410. doi: 10.3390/vaccines9050410.

OBJECTIVE

The aim of this meta-analysis was to discuss evidence supporting the efficacy of adjuvant human papillomavirus (HPV) vaccination in reducing the risk of recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical treatment.

METHODS

A systematic literature search was performed for studies reporting the impact of HPV vaccination on reducing the risk of recurrence of CIN 2+ after surgical excision. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).

RESULTS

Eleven studies met the inclusion criteria and were selected for analysis. In total, 21,310 patients were included: 4039 (19%) received peri-operational adjuvant HPV vaccination while 17,271 (81%) received surgery alone. The recurrence of CIN 2+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.35; 95% CI 0.21-0.56; < 0.0001). The recurrence of CIN 1+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.51; 95% CI 0.31-0.83; = 0.006). A non-significant trend of reduction rate of HPV persistence was observed in the vaccinated compared with the unvaccinated cohorts (OR was 0.84; 95% CI 0.61-1.15; = 0.28).

CONCLUSIONS

HPV vaccination, in adjuvant setting, is associated with a reduced risk of recurrent CIN 1+ and CIN 2+ after surgical treatment.

目的

本荟萃分析旨在探讨支持辅助性人乳头瘤病毒（HPV）疫苗接种在降低手术治疗后复发性宫颈上皮内瘤变（CIN）2级或更高级别风险方面疗效的证据。

方法

对报告HPV疫苗接种对手术切除后CIN 2+复发风险影响的研究进行系统文献检索。结果以平均差异或合并比值比（OR）及95%置信区间（95%CI）报告。

结果

11项研究符合纳入标准并被选入分析。总共纳入21310例患者：4039例（19%）接受围手术期辅助性HPV疫苗接种，而17271例（81%）仅接受手术。与未接种疫苗组相比，接种疫苗组治疗后CIN 2+的复发率显著更低（OR 0.35；95%CI 0.21 - 0.56；P<0.0001）。与未接种疫苗组相比，接种疫苗组治疗后CIN 1+的复发率显著更低（OR 0.51；95%CI 0.31 - 0.83；P = 0.006）。与未接种疫苗队列相比，接种疫苗队列中HPV持续感染率有降低趋势但不显著（OR为0.84；95%CI 0.61 - 1.15；P = 0.28）。