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)?
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)?
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DOI：
10.1016/j.ygyno.2013.04.050
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发表时间：
2013-08-01
影响因子：
4.7
通讯作者：
Kim, Seok Mo
中科院分区：
文献类型：
--
作者：
Kang, Woo Dae;Choi, Ho Sun;Kim, Seok Mo
目标.本研究旨在探讨宫颈电环切除术（LEEP）后接种四价人乳头瘤病毒（HPV）疫苗是否能有效预防高度宫颈上皮内瘤变（CIN 2 - 3）的复发。2007年8月至2010年7月，对737例年龄20-45岁确诊为CIN 2 -3的患者行LEEP治疗并随访。360例患者在LEEP术后接种四价HPV疫苗（接种组），377例患者未接种疫苗（未接种组）。接种组在LEEP后1周接受第一剂，其余两剂分别在2个月和6个月后接受。在前2年的第3、6、9、12、18和24个月以及此后每年进行LEEP后随访。结果。不考虑致病HPV类型，36例（4.9%）患者复发。在疫苗接种组（360例患者）中，9例患者（2.5%）复发，而非疫苗接种组（377例患者）中有27例患者（7.2%）复发。HPV 16型和/或18型感染者中，接种组197例（5例，2.5%）和未接种组211例（18例，8.5%）LEEP术后复发与疫苗HPV 16型或18型有关（P < 0.01）。多因素分析显示LEEP术后未接种疫苗是CIN 2 -3复发的独立危险因素（HR = 2.840，95%可信区间1335 ~ 6.042，P < 0.01）。治疗后可考虑接种四价HPV疫苗预防CIN 2 -3复发。(c)2013作者爱思唯尔公司出版All right reserved.
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, 1335-6.042; P < 0.01).Conclusions. Vaccination with the quadrivalent HPV vaccine after treatment may be considered in preventing recurrence of CIN2-3. (c) 2013 The Authors. Published by Elsevier Inc. All right reserved.