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

Area of Science:

• Gynecology
• Oncology
• Vaccinology

Background:

• Cervical cancer prevention relies heavily on Human Papillomavirus (HPV) vaccination.
• The efficacy of HPV vaccination in conjunction with excisional treatment for high-grade cervical intraepithelial neoplasia (CIN 3) requires further clarification.

Purpose of the Study:

• To evaluate the impact of HPV vaccination on the recurrence of cervical intraepithelial neoplasia (CIN 2+) following surgical excision.

Main Methods:

• A systematic review and meta-analysis of six studies (three retrospective, three prospective), including post-hoc analyses of RCTs and a cancer registry study.
• Random-effect models were employed to assess the influence of HPV vaccination (pre- or post-conization) on recurrent CIN 2+.

Main Results:

• The meta-analysis included 21,059 patients, with 3,939 receiving HPV vaccination.
• HPV vaccination demonstrated a significant risk reduction for new high-grade intraepithelial lesions (RR 0.41; 95% CI [0.27; 0.64]), irrespective of HPV type.
• Sub-analyses showed consistent benefits across different age groups and for HPV 16/18 positive cases, with a number needed to vaccinate (NNV) of 45.5.

Conclusions:

• HPV vaccination, when administered alongside surgical excision for CIN 3, significantly lowers the risk of recurrent cervical intraepithelial neoplasia.
• The findings underscore the potential of HPV vaccination as an adjuvant therapy to improve outcomes after excisional treatment for high-grade cervical lesions.