Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)?

Gynecol Oncol. 2013 Aug;130(2):264-8. doi: 10.1016/j.ygyno.2013.04.050. Epub 2013 Apr 26.

Abstract

Objectives: This study was conducted to determine whether vaccination with the quadrivalent human papillomavirus (HPV) vaccine after loop electrosurgical excision procedure (LEEP) for high-grade cervical intraepithelial neoplasia (CIN2-3) is effective in preventing recurrence of CIN2-3.

Methods: Between August 2007 and July 2010, 737 patients aged 20-45 years who were diagnosed with CIN2-3 were treated by LEEP and followed. Three hundred and sixty patients were vaccinated with the quadrivalent HPV vaccine after LEEP (vaccination group), and 377 patients were followed without vaccination (non-vaccination group). The vaccination group received the first dose at 1 week after LEEP and the remaining two doses two and six months later. Post-LEEP follow-up was performed at 3, 6, 9, 12, 18, and 24 months during the first 2 years and yearly thereafter.

Results: Irrespective of causal HPV type, 36 (4.9%) patients developed recurrence. In the vaccination group (360 patients), 9 patients (2.5%) developed recurrence, whereas 27 patients (7.2%) in the non-vaccination group (377 patients) developed recurrence. In patients infected with HPV of 16 and/or 18 type, 5 patients (2.5%) in the vaccination group (197 patients) and 18 patients (8.5%) in the non-vaccination group (211 patients) developed recurrent disease related to vaccine HPV types (HPV 16 or 18 types) after LEEP (P<0.01). Multivariate analysis showed that no vaccination after LEEP was an independent risk factor for recurrent CIN2-3 (HR=2.840; 95% confidence interval, 1.335-6.042; P<0.01).

Conclusions: Vaccination with the quadrivalent HPV vaccine after treatment may be considered in preventing recurrence of CIN2-3.

Keywords: HPV; High grade CIN; LEEP; Vaccine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervical Intraepithelial Neoplasia / prevention & control*
  • Cervical Intraepithelial Neoplasia / surgery
  • Electrosurgery / methods*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local / prevention & control*
  • Papillomavirus Vaccines / immunology*
  • Proportional Hazards Models
  • Retrospective Studies
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / surgery
  • Vaccination*

Substances

  • Papillomavirus Vaccines