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

Purpose After excisional treatment of high grade squamous intraepithelial lesions (HSIL) women continue to have an elevated risk to re-develop HPV-related disease including invasive cervical cancer. Whereas recent studies have shown that progression from HPV infection to precancerous lesions cannot be stopped by HPV vaccination without surgical intervention, this meta-analysis was performed to evaluate the effects of pre- and post-conization HPV-vaccination.

Methods In this meta-analysis, one retrospective and two prospective studies, three post-hoc analyses and one cancer registry study were included after a systematic review of literature. Fixed- and random-effect models were prepared to evaluate the influence of vaccination on recurrent HSIL.

Results Primary end point was CIN2+ in every study. The study population included 20,188 patients (3,501 vaccinations vs 16,687 controls). Results showed a significant risk reduction of 36 % for the development of new HSIL after HPV vaccination and surgery (risk rate (RR) 0.64; 95 % CI [0.53; 0.78]), independent from HPV type. The number needed to vaccinate (NNV) was 47. Multiple sub analyses were performed. Results for HPV 16/18 related CIN2+ showed a RR of 0.41 (95 % CI [0.2; 0.85]. Younger women’s RR (age 18-26) was 0.4; 95 % CI [0.21; 0.76] compared to studies not discriminating between ages (age 17-51): 0.68; 95 % CI [0.55; 0.83]. The relative risk of vaccination before and after operative therapy was 0.52; 95 % CI [0.34; 0.79] and 0.69; 95 % CI [0.55; 0.86], respectively.

Conclusion Meta-analysis and subgroup analyses showed a significant risk reduction to develop recurrent HSIL after surgical excision and HPV vaccination.

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Publication History

Article published online:
07 October 2020