Assessing the Long-Term Role of Vaccination against HPV after Loop Electrosurgical Excision Procedure (LEEP): A Propensity-Score Matched Comparison

Giorgio Bogani, Francesco Raspagliesi, Francesco Sopracordevole, Andrea Ciavattini, Alessandro Ghelardi, Tommaso Simoncini, Marco Petrillo, Francesco Plotti, Salvatore Lopez, Jvan Casarin, Maurizio Serati, Ciro Pinelli, Gaetano Valenti, Alice Bergamini, Barbara Giannella, Andrea Dell’Acqua, Ermelinda Monti, Paolo Vercellini, Giovanni D’ippolito, Lorenzo AguzzoliVincenzo D Mandato, Paola Carunchio, Gabriele Carlifante, Luca Giannella, Cono Scaffa, Francesca Falcone, Stefano Ferla, Chiara Borghi, Antonino Ditto, Mario Malzoni, Andrea Giannini, Maria Giovanna Salerno, Viola Liberale, Biagio Contino, Cristina Donfrancesco, Michele Desiato, Anna Myriam Perrone, Giulia Dondi, Pierandrea De Iaco, Umberto Leone Roberti Maggiore, Mauro Signorelli, Valentina Chiappa, Simone Ferrero, Giuseppe Sarpietro, Maria G Matarazzo, Antonio Cianci, Sara Bocio, Simona Ruisi, Rocco Guerrisi, Claudia Brusadelli, Lavinia Mosca, Raffaele Tinelli, Rosa De Vincenzo, Gian Franco Zannoni, Gabriella Ferrandina, Salvatore Dessole, Roberto Angioli, Stefano Greggi, Arsenio Spinillo, Fabio Ghezzi, Nicola Colacurci, Margherita Fischetti, Annunziata Carlea, Fulvio Zullo, Ludovico Muzii, Giovanni Scambia, Pierluigi Benedetti Panici, Violante Di Donato

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Abstract

Background: Primary prevention through vaccination is a prophylactic approach aiming to reduce the risk of developing human papillomavirus (HPV)-related lesions. No mature and long-term data supported the adoption of vaccination in women undergoing conization. Methods: This is a retrospective multi-institutional study. Charts of consecutive patients undergoing conization between 2010 and 2014 were collected. All patients included had at least 5 years of follow-up. We compared outcomes of patients undergoing conization plus vaccination and conization alone. A propensity-score matching algorithm was applied in order to reduce allocation biases. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, charts of 1914 women were analyzed. The study group included 116 (6.1%) and 1798 (93.9%) women undergoing conization plus vaccination and conization alone, respectively. Five-year recurrence rate was 1.7% (n = 2) and 5.7% (n = 102) after conization plus vaccination and conization alone, respectively (p = 0.068). After the application of a propensity-score matching, we selected 100 patients undergoing conization plus vaccination and 200 patients undergoing conization alone. The crude number of recurrences was 2 (2%) and 11 (5.5%) for patients undergoing conization plus vaccination and conization alone, respectively (p = 0.231). Vaccination had no impact on persistent lesions (no negative examination between conization and new cervical dysplasia; p = 0.603), but reduced the risk of recurrent disease (patients who had at least one negative examination between conization and the diagnosis of recurrent cervical dysplasia; p = 0.031). Conclusions: Patients having vaccination experience a slightly lower risk of recurrence than women who had not, although not statistically significantly different. Further evidence is needed to assess the cost effectiveness of adopting vaccination in this setting.
Original languageUndefined/Unknown
JournalVaccines
Volume8
Issue number4
DOIs
Publication statusPublished - 2020

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