Abstract
Objective: To assess evidence on the efficacy of adjuvant human papillomavirus (HPV) vaccination in patients treated for HPV-related disease across different susceptible organ sites. Methods: A systematic review was conducted to identify studies addressing the efficacy of adjuvant HPV vaccination on reducing the risk of recurrence of HPV-related preinvasive diseases. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Results: Sixteen studies were identified for the final analysis. Overall, 21,472 patients with cervical dysplasia were included: 4132 (19.2%) received the peri-operative HPV vaccine, while 17,340 (80.8%) underwent surgical treatment alone. The recurrences of CIN 1+ (OR 0.45, 95% CI 0.27 to 0.73; p = 0.001), CIN 2+ (OR 0.33, 95% CI 0.20 to 0.52; p < 0.0001), and CIN 3 (OR 0.28, 95% CI 0.13 to 0.59; p = 0.0009) were lower in the vaccinated than in unvaccinated group. Similarly, adjuvant vaccination reduced the risk of developing anal intraepithelial neoplasia (p = 0.005) and recurrent respiratory papillomatosis (p = 0.004). No differences in anogenital warts and vulvar intraepithelial neoplasia recurrence rate were observed comparing vaccinated and unvaccinated individuals. Conclusions: Adjuvant HPV vaccination is associated with a reduced risk of CIN recurrence, although there are limited data regarding its role in other HPV-related diseases. Further research is warranted to shed more light on the role of HPV vaccination as adjuvant therapy after primary treatment.
Highlights
Prophylactic human papillomavirus (HPV) vaccines are considered to be the most successful and cost-effective public health measure to prevent HPV infection and related cancers across different organ sites [1]
This study suggested that adjuvant HPV vaccination after surgical treatment for Anal intraepithelial neoplasia (AIN) significantly reduced the risk of disease recurrence (p = 0.005)
The present meta-analysis added another study (Karimi et al, 2020) [31] with 312 more patients to the previous analysis by Di Donato et al [39], and confirmed that HPV vaccination reduces the risk of Cervical intraepithelial neoplasia (CIN) recurrence
Summary
Prophylactic human papillomavirus (HPV) vaccines are considered to be the most successful and cost-effective public health measure to prevent HPV infection and related cancers across different organ sites [1]. Approved the first HPV vaccine designed to prevent HPV-related cancer (Gardasil® ). The vaccine was initially approved for women, and expanded to men in 2009. These vaccines consist of noninfectious, HPV-like particles that elicit the production of neutralizing L1-specific antibodies blocking the viral entry into host cells. According to the updated recommendations of the Advisory Committee on Immunization Practices (ACIP), HPV vaccination is intended for both females and males aged 9 to 26 years [4]. All HPV vaccines are highly immunogenic, with more than 98% of recipients developing antibodies within one month after completing vaccination, and they seem to provide protection for at least 10 years [5]
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