Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis.
Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis.
复制标题
人乳头瘤病毒（HPV）疫苗接种对局部手术治疗后HPV感染和HPV相关疾病复发的作用：系统回顾和荟萃分析
DOI：
10.1136/bmj-2022-070135
复制
发表时间：
2022-08-03
影响因子：
105.7
通讯作者：
Kyrgiou, Maria
中科院分区：
文献类型：
--
作者：
Kechagias, Konstantinos S.;Kalliala, Ilkka;Bowden, Sarah J.;Athanasiou, Antonios;Paraskevaidi, Maria;Paraskevaidis, Evangelos;Dillner, Joakim;Nieminen, Pekka;Strander, Bjorn;Sasieni, Peter;Veroniki, Areti Angeliki;Kyrgiou, Maria
目的探讨接种人乳头状瘤病毒(HPV)疫苗对局部手术患者HPV感染风险及与HPV感染相关疾病复发的影响。从最初到2021年3月31日对PubMed(Medline)、Scope us、Cochrane、Web of Science和ClinicalTrials.gov进行了系统审查和荟萃分析。研究报告了接种疫苗的个体在局部手术治疗侵袭前生殖器疾病后HPV感染的风险和与HPV感染相关的疾病的复发。主要的结果衡量指标是局部手术治疗后宫颈上皮内瘤变2级或更高级别(CIN2+)的复发风险，并根据个别研究的报告进行随访。次要结果指标是HPV感染的风险或与HPV感染相关的其他损害。分别使用Robins-I和Rob-2工具进行独立和重复数据提取和质量评估，用于观察性研究和随机对照试验。对初步结果实施评估、发展和评价(等级)建议分级。观察性研究和随机对照试验分别与随机对照试验的后期分析分开分析。用随机效应Meta分析模型计算合并风险比和95%可信区间。用约束极大似然法作为异质性的估计量，用Hartung-Knapp-Sidik-Jonkman方法求取可信区间。22篇文章符合审查的纳入标准；其中18篇研究还报告了来自未接种疫苗组的数据，并被纳入荟萃分析(12项观察性研究、2项随机对照试验和4项随机对照试验的后期分析)。与未接种的人相比，接种疫苗的人复发风险降低(11项研究，19名 909参与者；风险比0.43，95%可信区间0.30-0.60；I2=58%，τ2=0.14，中位随访36个月，四分位数范围24-43.5.)当对与HPV16型或HPV18型相关的疾病评估CIN2+的复发风险时，效果估计甚至更强(6项研究，1879名参与者；风险比0.26，95%可信区间0.16至0.43；I2=0%，τ2=0)。对CIN2+总体和与HPV16或HPV18相关的CIN2+的荟萃分析的置信度从非常低到中等不等，可能是因为荟萃分析中所包括的研究中的发表偏见和不一致。接种疫苗但不确定性很大的患者的复发风险也降低了(三项研究，17名 757参与者；0.28，0.01至6.37；I2=71%，τ2=1.23)。外阴、阴道和肛门上皮内瘤变、生殖器疣以及持续性和偶发性HPV感染的复发缺乏益处的证据，尽管每种结果的研究和参与者的数量都很少。在接受局部切除治疗的妇女中，接种HPV疫苗可能会降低CIN的复发风险，特别是在与HPV16或HPV18相关的情况下。对证据质量的等级评估表明，数据不是决定性的。需要进行大规模、高质量的随机对照试验，以确定接受HPV感染相关疾病治疗的妇女接种HPV疫苗的有效性和成本水平。PROSPERO CRD42021237350。
To explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment. Systematic review and meta-analysis PubMed (Medline), Scopus, Cochrane, Web of Science, and ClinicalTrials.gov were screened from inception to 31 March 2021. Studies reporting on the risk of HPV infection and recurrence of disease related to HPV infection after local surgical treatment of preinvasive genital disease in individuals who were vaccinated were included. The primary outcome measure was risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) after local surgical treatment, with follow-up as reported by individual studies. Secondary outcome measures were risk of HPV infection or other lesions related to HPV infection. Independent and in duplicate data extraction and quality assessment were performed with ROBINS-I and RoB-2 tools for observational studies and randomised controlled trials, respectively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was implemented for the primary outcome. Observational studies and randomised controlled trials were analysed separately from post hoc analyses of randomised controlled trials. Pooled risk ratios and 95% confidence intervals were calculated with a random effects meta-analysis model. The restricted maximum likelihood was used as an estimator for heterogeneity, and the Hartung-Knapp-Sidik-Jonkman method was used to derive confidence intervals. 22 articles met the inclusion criteria of the review; 18 of these studies also reported data from a non-vaccinated group and were included in the meta-analyses (12 observational studies, two randomised controlled trials, and four post hoc analyses of randomised controlled trials). The risk of recurrence of CIN2+ was reduced in individuals who were vaccinated compared with those who were not vaccinated (11 studies, 19 909 participants; risk ratio 0.43, 95% confidence interval 0.30 to 0.60; I2=58%, τ2=0.14, median follow-up 36 months, interquartile range 24-43.5). The effect estimate was even stronger when the risk of recurrence of CIN2+ was assessed for disease related to HPV subtypes HPV16 or HPV18 (six studies, 1879 participants; risk ratio 0.26, 95% confidence interval 0.16 to 0.43; I2=0%, τ2=0). Confidence in the meta-analysis for CIN2+ overall and CIN2+ related to HPV16 or HPV18, assessed by GRADE, ranged from very low to moderate, probably because of publication bias and inconsistency in the studies included in the meta-analysis. The risk of recurrence of CIN3 was also reduced in patients who were vaccinated but uncertainty was large (three studies, 17 757 participants; 0.28, 0.01 to 6.37; I2=71%, τ2=1.23). Evidence of benefit was lacking for recurrence of vulvar, vaginal, and anal intraepithelial neoplasia, genital warts, and persistent and incident HPV infections, although the number of studies and participants in each outcome was low. HPV vaccination might reduce the risk of recurrence of CIN, in particular when related to HPV16 or HPV18, in women treated with local excision. GRADE assessment for the quality of evidence indicated that the data were inconclusive. Large scale, high quality randomised controlled trials are required to establish the level of effectiveness and cost of HPV vaccination in women undergoing treatment for diseases related to HPV infection. PROSPERO CRD42021237350.
登录
查看更多内容
DOI：
10.1136/bmj.e1401
发表时间：
2012-03-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Joura EA;Garland SM;Paavonen J;Ferris DG;Perez G;Ault KA;Huh WK;Sings HL;James MK;Haupt RM;FUTURE I and II Study Group
通讯作者：
FUTURE I and II Study Group
影响因子：
7
作者：
Huedo-Medina, Tania B.;Sanchez-Meca, Julio;Botella, Juan
通讯作者：
Botella, Juan
影响因子：
51.1
作者：
Athanasiou, Antonios;Veroniki, Areti Angeliki;Efthimiou, Orestis;Kalliala, Ilkka;Naci, Huseyin;Bowden, Sarah;Paraskevaidi, Maria;Arbyn, Marc;Lyons, Deirdre;Martin-Hirsch, Pierre;Bennett, Phillip;Paraskevaidis, Evangelos;Salanti, Georgia;Kyrgiou, Maria
通讯作者：
Kyrgiou, Maria
影响因子：
4.7
作者：
Kang, Woo Dae;Choi, Ho Sun;Kim, Seok Mo
通讯作者：
Kim, Seok Mo
影响因子：
4.5
作者：
Karimi-Zarchi, Mojgan;Allahqoli, Leila;Alkatout, Ibrahim
通讯作者：
Alkatout, Ibrahim