Surgical Treatment of Vulvar HSIL: Adjuvant HPV Vaccine Reduces Recurrent Disease

Alessandro Ghelardi,Gloria Bertacca,Stefania Lombardi,Francesco Sopracordevole,Roberto Marrai,Giorgio Bogani,Elmar A Joura,Arianna Tonetti,Paola Bay

doi:10.3390/vaccines9020083

Abstract

Data suggest that adjuvant human papillomavirus (HPV)-vaccination in women treated for cervical HPV diseases reduces recurrent disease. This study investigates adjuvant HPV-vaccination and the rate of recurrence in women undergoing surgery for vulvar high-grade squamous intraepithelial lesions (HSIL). From January 2013 to April 2020, we enrolled 149 women in a prospective case-control study. The control group (NV-group) was treated by standard surgery alone, while the study group received adjuvant vaccination soon after surgery (V-group). A follow-up was performed by vulvoscopy and HPV test. Statistical analysis was performed by Fisher’s exact test. HSIL recurrence was observed in 24/76 (32%) patients in NV-group and in 8/42 patients (19%) of the vaccinated group. By analysing the recurrence rate related to the incident and reactivated latent HPV infection, we found a significant difference between (17/76) 22.3% in NV-group and (2/42) 4.8% in V-group (p = 0.01). A reduction of 78.5% in incident/reactivated HPV infections was demonstrated. Data results add to the current knowledge about the mechanism of post-surgical adjuvant HPV vaccination. Our prospective study is the first to document the vaccine clinical effectiveness in preventing “reactivation” of latent HPV infections. Quadrivalent HPV vaccine administered after the surgical treatment for vulvar HSIL appears to be useful in preventing recurrent disease.

Highlights

High-risk human papillomavirus (HPV) types cause approximately 5% of all cancers worldwide [1]
The aim of this study was to investigate possible implications of receiving adjuvant HPV vaccination, in individuals surgically treated for vulvar H-SIL, evaluating the clinical effectiveness of the human papillomavirus 4-valent vaccine in preventing disease relapse after surgery
All the patients treated for vulvar high-grade squamous intraepithelial lesions (HSIL) were invited to a counselling session, which was performed in the SPERANZA vaccination clinic

Summary

Introduction

High-risk human papillomavirus (HPV) types cause approximately 5% of all cancers worldwide [1]. In the United States, high-risk HPV types cause approximately 3% of all cancer cases among women and 2% of all cancer cases among men [2]. All cases of cervical cancer are caused by HPV, and just two HPV types, 16 and 18, are responsible for about 70% of all cases. Persistent human papillomavirus infection with oncogenic types has been linked to 70% of vulvar cancers [3]. In Italy, it is estimated that there are about 2600 new cases/year of cancer of the cervix and 390 cases/year of vaginal-vulvar tumours [4]. A recent article shows the average lifetime probability of acquiring HPV among those with at least one opposite-sex partner to be 84.6% (range, 53.6–95.0%) for women and 91.3%

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