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Adjuvant Human Papillomavirus Vaccine to Reduce Recurrent Cervical Dysplasia in Unvaccinated Women: A Systematic Review and Meta-analysis

Lichter, Katie ; Krause, Danielle ; Xu, Jingwen ; Tsai, Sung Huang Laurent ; Hage, Camille ; Weston, Erica ; Eke, Ahizechukwu ; Levinson, Kimberly

Obstetrics and gynecology (New York. 1953), 2020-05, Vol.135 (5), p.1070-1083 [Periódico revisado por pares]

United States: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved

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  • Título:
    Adjuvant Human Papillomavirus Vaccine to Reduce Recurrent Cervical Dysplasia in Unvaccinated Women: A Systematic Review and Meta-analysis
  • Autor: Lichter, Katie ; Krause, Danielle ; Xu, Jingwen ; Tsai, Sung Huang Laurent ; Hage, Camille ; Weston, Erica ; Eke, Ahizechukwu ; Levinson, Kimberly
  • Assuntos: Adult ; Cervical Intraepithelial Neoplasia - drug therapy ; Cervical Intraepithelial Neoplasia - surgery ; Cervical Intraepithelial Neoplasia - virology ; Chemotherapy, Adjuvant ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local - prevention & control ; Neoplasm Recurrence, Local - virology ; Papillomavirus Infections - complications ; Papillomavirus Infections - virology ; Papillomavirus Vaccines - therapeutic use ; Treatment Outcome ; Uterine Cervical Neoplasms - drug therapy ; Uterine Cervical Neoplasms - surgery ; Uterine Cervical Neoplasms - virology ; Young Adult
  • É parte de: Obstetrics and gynecology (New York. 1953), 2020-05, Vol.135 (5), p.1070-1083
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
    content type line 23
    ObjectType-Undefined-3
  • Descrição: OBJECTIVE:To perform a systematic review and meta-analysis evaluating the efficacy of adjuvant human papillomavirus (HPV) vaccination in preventing recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical excision. DATA SOURCES:Electronic databases (Cochrane, PubMed, EMBASE, MEDLINE, Scopus, and ClinicalTrials.gov) were searched for studies comparing surgical excision alone to surgical excision with adjuvant HPV vaccination for CIN 2 or greater. Studies published from January 1990 to January 2019 were included. METHODS:A total of 5,901 studies were reviewed. The primary outcomes evaluated includedrecurrence of CIN 2 or greater, CIN 1 or greater, and HPV 16,18 associated CIN within 6–48 months. We used Covidence software to assist with screening, and meta-analysis was performed using Review Manager. TABULATION, INTEGRATION, AND RESULTS:Six studies met inclusion criteria and were included in the final analysis. In total 2,984 women were included; 1,360 (45.6%) received adjuvant HPV vaccination after surgical excision, and 1,624 (54.4%) received either placebo or surgical management alone for CIN 2 or greater. Recurrence of CIN 2 or greater occurred within 6–48 months in 115 women (3.9%) overall; however, recurrence was significantly lower for vaccinated women26 of 1,360 women (1.9%) vs 89 of 1,624 unvaccinated women (5.9%) (relative risk [RR] 0.36 95% CI 0.23–0.55). The risk of CIN 1 or greater was also significantly lower with adjuvant HPV vaccination, occurring in 86 of 1,360 vaccinated women (6.3%) vs 157 of 1,624 unvaccinated women (9.7%) (RR 0.67 95% CI 0.52–0.85). Thirty-five women developed recurrent CIN 2 or greater lesions specific to HPV 16,18; nine received adjuvant vaccination (0.9%) vs 26 who were unvaccinated (2.0%) (RR 0.41 95% CI 0.20–0.85). CONCLUSION:Adjuvant HPV vaccination in the setting of surgical excision for CIN 2 or greater is associated with a reduced risk of recurrent cervical dysplasia overall and a reduction in the risk of recurrent lesions caused by the most oncogenic strains (HPV 16,18). Human papillomavirus vaccination should therefore be considered for adjuvant treatment in patients undergoing surgical excision for CIN 2 or greater. SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42019123786.
  • Editor: United States: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved
  • Idioma: Inglês
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