Abstract
Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6–12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22–0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group (p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment (p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.
Highlights
Persistent High Risk-Human Papillomavirus (HR-human papillomavirus (HPV)) infections are strongly associated with the development of High-grade Squamous Intraepithelial Lesion/CervicalIntraepithelial Neoplasia (HSIL/CIN) 2-3 [1,2]
Patients diagnosed with HSIL/CIN 2-3 were referred to HPV vaccination
A negative result in the conization specimen was found in 34 patients treated by punch biopsy of HSIL/CIN 2-3: 26 were from biopsies with HSIL/CIN2 and 8 with
Summary
Persistent High Risk-Human Papillomavirus (HR-HPV) infections are strongly associated with the development of High-grade Squamous Intraepithelial Lesion/CervicalIntraepithelial Neoplasia (HSIL/CIN) 2-3 [1,2]. Patients who have received excisional therapy (conization) for HSIL/CIN 2-3 have a 0.4–19% risk of lesion recurrence [5]. These women have a 5–10-fold higher risk of developing cervical cancer over the following 10–20 years compared with the general population [6,7]. Lesions (SIL)/CIN may result in a reduction in subsequent disease during follow-up [8,9,10,11]. It seems that, immunologically, women undergoing a Loop Electrosurgical
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