Assessing the long-term role of vaccination against hpv after loop electrosurgical excision procedure (Leep): A propensity-score matched comparison

2020

VACCINES

Assessing the long-term role of vaccination against hpv after loop electrosurgical excision procedure (Leep): A propensity-score matched comparison

01 Pubblicazione su rivista

Bogani G., Raspagliesi F., Sopracordevole F., Ciavattini A., Ghelardi A., Simoncini T., Petrillo M., Plotti F., Lopez S., Casarin J., Serati M., Pinelli C., Valenti G., Bergamini A., Gardella B., Dell'acqua A., Monti E., Vercellini P., D'ippolito G., Aguzzoli L., Mandato V. D., Carunchio P., Carlifante G., Giannella L., Scaffa C., Falcone F., Ferla S., Borghi C., Ditto A., Malzoni M., Giannini A., Salerno M. G., Liberale V., Contino B., Donfrancesco C., Desiato M., Perrone A. M., Dondi G., De Iaco P., Maggiore U. L. R., Signorelli M., Chiappa V., Ferrero S., Sarpietro G., Matarazzo M. G., Cianci A., Bocio S., Ruisi S., Guerrisi R., Brusadelli C., Mosca L., Tinelli R., De Vincenzo R., Zannoni G. F., Ferrandina G., Dessole S., Angioli R., Greggi S., Spinillo A., Ghezzi F., Colacurci N., Fischetti M., Carlea A., Zullo F., Muzii L., Scambia G., Panici P. B., Di Donato V.

DOI: 10.3390/vaccines8040717

ISSN: 2076-393X

Background: Primary prevention through vaccination is a prophylactic approach aiming to reduce the risk of developing human papillomavirus (HPV)-related lesions. No mature and long-term data supported the adoption of vaccination in women undergoing conization. Methods: This is a retrospective multi-institutional study. Charts of consecutive patients undergoing conization between 2010 and 2014 were collected. All patients included had at least 5 years of follow-up. We compared outcomes of patients undergoing conization plus vaccination and conization alone. A propensity-score matching algorithm was applied in order to reduce allocation biases. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, charts of 1914 women were analyzed. The study group included 116 (6.1%) and 1798 (93.9%) women undergoing conization plus vaccination and conization alone, respectively. Five-year recurrence rate was 1.7% (n = 2) and 5.7% (n = 102) after conization plus vaccination and conization alone, respectively (p = 0.068). After the application of a propensity-score matching, we selected 100 patients undergoing conization plus vaccination and 200 patients undergoing conization alone. The crude number of recurrences was 2 (2%) and 11 (5.5%) for patients undergoing conization plus vaccination and conization alone, respectively (p = 0.231). Vaccination had no impact on persistent lesions (no negative examination between conization and new cervical dysplasia; p = 0.603), but reduced the risk of recurrent disease (patients who had at least one negative examination between conization and the diagnosis of recurrent cervical dysplasia; p = 0.031). Conclusions: Patients having vaccination experience a slightly lower risk of recurrence than women who had not, although not statistically significantly different. Further evidence is needed to assess the cost effectiveness of adopting vaccination in this setting.

HPV LEEP vaccination