Effectiveness of Prophylactic Human Papillomavirus Vaccine in the Prevention of Recurrence in Women Conized for HSIL/CIN 2-3: The VENUS Study

Abstract

Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6–12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22–0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group (p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment (p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.

Recurrent or primary metastatic cervical cancer: current and future treatments

“…This could probably be a better approach, avoiding toxicity of ICIs. 95,96 The limitation for a rapidly expanding use of all these new therapeutic approaches is the emerging evidence of disparities in access to these highly effective but expensive treatments. These inequalities in treatment, but also in screening and HPV vaccination accesses, in many developing countries probably contribute to the absence of improvement in the global OS of this disease.…”

Post-Conization HPV Vaccination and Its Impact on Viral Status: A Retrospective Cohort Study in Troms and Finnmark, 2022

“…Evidence from multiple studies indicates that post-conization HPV vaccination may play a preventative role in the recurrence of high-grade intraepithelial neoplasia (CIN2+) [16][17][18]. Our research identified a notable reduction in HPV positivity rates at six months after conization, from 35.5% in the unvaccinated group to 23.4% in the vaccinated group.…”

“…Emerging research suggests that the HPV vaccine has the potential to prevent recurrence of high-grade cervical dysplasia post-conization [15][16][17][18], and yet there is a lack of consensus or national guidelines endorsing post-treatment HPV vaccination for CIN2+ [19]. Consequently, the decision to recommend vaccination post-conization is left to individual gynecologists, which, combined with out-of-pocket costs [14], leads to disparities in vaccine uptake among treated women.…”

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

“…This latter group might be highly selected, thus not reflecting the real impact of vaccination in the whole cohort of women undergoing treatment for HPV-related disease [16]. However, several other studies confirm the benefit of HPV vaccination in women treated for HSIL/CIN 2-3 [17][18][19][20]. (iii) For these reasons, our results are not applicable in women who had received prophylactic vaccination before the diagnosis of cervical dysplasia.…”