HPV vaccination after LEEP. A systematic review and meta-analysis.
Abstract
Background: Prophylactic human papillomavirus (HPV) vaccines are highly
effective in reducing premalignant lesions of the cervix. Recurrence is
reported up to 17%. Little is known about the effect of HPV vaccines on
women with CIN who already are HPV infected and CIN. Objective: Review
of the literature addressing the question whether adjuvant vaccination
with an HPV-vaccine in addition to LEEP treatment is effective in
preventing recurrence of CIN-lesions. Search strategy: Medline search
using Mesh terms. Selection criteria: Studies on HPV vaccination in
addition to a LEEP procedure. One of the study parameters had to
describe the effect of vaccination in addition to a surgical treatment.
Data collection and Analysis: All results were assessed by two reviewers
and meta-analysis performed. Main result: Six studies met the inclusion
and exclusion criteria: one case report, three post-hoc analyses, one
case-control study and one retrospective study. In the post-hoc analysis
of three community-based clinical trials; the combined recurrence rate
of CIN2+ was 1.49% (12/806) in the HPV- vaccinated group versus 3.51%
(37/1052) in the non-HPV vaccinated group, with a combined RR of 0.41
(95% CI 0.21-0.78; P<0.01). The retrospective and the
case-control study combined, reported an incidence of 2.07% (11/532)
versus 6.92% (38/549) in favor for HPV vaccination, resulting in a
significant positive vaccination effect in addition to LEEP treatment
(RR 0.30 95%CI 0.16-0.58; P<0.01). Funding: None Keywords:
HPV, CIN, VACCINACTION, LEEP