HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Selection Criteria
2.2. Liquid-Based Cytology and HPV Testing
2.3. Pre-Treatment Histological Diagnosis
2.4. Excisional Treatment and Histological Diagnosis of the Surgical Specimen
2.5. Post-Treatment Follow-Up
2.6. HPV Vaccination Policy
2.7. Clinical Outcomes and Definitions
2.8. Data Analysis
3. Results
3.1. Clinical Characteristics of the Vaccinated and Non-Vaccinated Women
3.2. Vaccination Schedule and Cervical Treatment
3.3. Clinical Outcome in the First Control after Treatment
Post-Treatment HSIL in the First Control after Treatment According to Vaccination Status
3.4. Clinical Outcome at the End of the Follow-Up
Post-Treatment HSIL at the End of the Follow-Up According to Vaccination Status
3.5. Effect of Vaccination in Women with Persistent HPV Infection after Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
HSIL | high-grade cervical intraepithelial lesion |
HPV | human papillomavirus |
PCR | polymerase chain reaction |
LSIL | low-grade cervical intraepithelial lesion |
WHO | World Health Organization |
SD | standard deviation |
CIN | cervical intraepithelial neoplasia |
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Vaccinated Women (n = 306) | Non-Vaccinated Women (n = 92) | ||||
---|---|---|---|---|---|
n | (%) | n | (%) | p Value * | |
Age | 39.2 | ±9.1 | 41.8 | ±12.8 | 0.071 |
Smoking habit | 0.850 | ||||
Active smoker | 122 | (39.9) | 37 | (40.2) | |
Ex-smoker | 40 | (13.1) | 10 | (10.9) | |
Non-smoker | 105 | (34.3) | 33 | (35.9) | |
No data | 39 | (12.7) | 12 | (13.0) | |
HPV genotype (pre-treatment) | 0.103 | ||||
HPV16 and/or HPV18 | 191 | (62.4) | 46 | (50.0) | |
Other HPV types | 108 | (35.3) | 43 | (46.7) | |
HPV negative | 7 | (2.7) | 3 | (3.3) | |
Indication of treatment | <0.001 | ||||
Histological HSIL | 285 | (93.1) | 73 | (79.3) | |
HSIL in two Pap smears | 21 | (6.9) | 19 | (20.7) | |
Surgical specimen diagnosis | <0.001 | ||||
HSIL | 257 | (84.0) | 60 | (65.2) | |
LSIL | 22 | (7.2) | 18 | (19.6) | |
Negative | 27 | (8.8) | 14 | (15.2) | |
Margin of surgical specimen | 0.346 | ||||
Negative | 187 | (61.1) | 59 | (64.1) | |
Positive | 119 | (38.9) | 33 | (35.9) |
Clinical Outcome in the First Follow-Up Control | |||||||
---|---|---|---|---|---|---|---|
Post-Treatment HSIL (n = 9) | Post-Treatment HPV (n = 153) | No Evidence of Disease (n = 236) | |||||
n | (%) | n | (%) | n | (%) | p Value * | |
HPV genotype (pre-treatment) | 0.933 | ||||||
HPV16 and/or HPV18 | 6 | (2.5) | 90 | (38.0) | 141 | (59.5) | |
Other HPV types | 3 | (2.0) | 60 | (39.7) | 88 | (58.3) | |
HPV negative | 0 | (0.0) | 3 | (30.0) | 7 | (70.0) | |
Indication of treatment | 0.273 | ||||||
Histological HSIL | 8 | (2.2) | 133 | (37.2) | 217 | (60.6) | |
HSIL in two Pap smears | 1 | (2.5) | 20 | (50.0) | 19 | (47.5) | |
Diagnosis of surgical specimen | 0.546 | ||||||
HSIL | 8 | (2.5) | 127 | (40.1) | 182 | (57.4) | |
LSIL | 1 | (2.5) | 13 | (32.5) | 26 | (65.0) | |
Negative | 0 | (0.0) | 13 | (31.7) | 28 | (68.3) | |
Margin status of surgical specimen | 0.006 | ||||||
Negative | 3 | (1.2) | 83 | (33.7) | 160 | (65.1) | |
Positive | 6 | (3.9) | 70 | (46.1) | 76 | (50.0) | |
Vaccination status | 0.050 | ||||||
Before treatment | 1 | (0.9) | 33 | (29.2) | 79 | (69.9) | |
After treatment | 4 | (2.1) | 82 | (42.5) | 107 | (55.4) | |
Non-vaccinated women | 4 | (4.3) | 38 | (41.3) | 50 | (54.4) |
Clinical Outcome at the End of Follow-Up | |||||||
---|---|---|---|---|---|---|---|
Post-Treatment HSIL (n = 12) | Post-Treatment HPV (n = 75) | No Evidence of Disease (n = 311) | |||||
n | (%) | n | (%) | n | (%) | p Value * | |
HPV genotype (pre-treatment) | 0.568 | ||||||
HPV16 and/or HPV18 | 5 | (2.1) | 46 | (19.4) | 186 | (78.5) | |
Other HPV types | 7 | (4.6) | 28 | (18.6) | 116 | (76.8) | |
HPV negative | 0 | (0.0) | 1 | (10.0) | 9 | (90.0) | |
Indication of treatment | 0.105 | ||||||
Histological HSIL | 10 | (2.8) | 63 | (17.6) | 285 | (79.6) | |
HSIL in two Pap smears | 2 | (5.0) | 12 | (30.0) | 26 | (65.0) | |
Diagnosis of surgical specimen | 0.314 | ||||||
HSIL | 11 | (3.5) | 54 | (17.0) | 252 | (79.5) | |
LSIL | 1 | (2.5) | 11 | (27.5) | 28 | (70.0) | |
Negative | 0 | (0.0) | 10 | (24.4) | 31 | (75.6) | |
Margin status of surgical specimen | 0.337 | ||||||
Negative | 5 | (2.0) | 46 | (18.7) | 195 | (79.3) | |
Positive | 7 | (4.6) | 29 | (19.1) | 116 | (76.3) | |
Vaccination status | 0.199 | ||||||
Before treatment | 1 | (0.9) | 20 | (17.7) | 92 | (81.4) | |
After treatment | 5 | (2.6) | 38 | (19.7) | 150 | (77.7) | |
Non-vaccinated women | 6 | (6.5) | 17 | (18.5) | 69 | (75.0) |
Case | Age | Pre-Treatment HPV Genotype | Indication of Treatment | Diagnosis of Surgical Specimen | Margin Status | First Post-Treatment Control (6 m) | HPV Genotype at the End of Follow-Up | Vaccination Scheme | Doses | Time to Post-Treatment HSIL |
---|---|---|---|---|---|---|---|---|---|---|
Vaccinated women presenting post-treatment HSIL (n = 6) | ||||||||||
1 | 45.7 | Other HPV | Histological HSIL | HSIL | Negative | HSIL | Other HPV | After treatment | 3 | 8.8 |
2 | 41.7 | Other HPV | Histological HSIL | HSIL | Positive | HPV | Other HPV | After treatment | 3 | 35.9 |
3 | 48.1 | HPV 16/18 | Histological HSIL | HSIL | Positive | HSIL | HPV 16/18 | After treatment | 3 | 6.7 |
4 | 48.3 | HPV 16/18 | Histological HSIL | HSIL | Negative | HPV | HPV 16/18 | Before treatment | 3 | 23.2 |
5 | 35.6 | Other HPV | Histological HSIL | HSIL | Positive | HPV | Other HPV | After treatment | 1 | 15.0 |
6 | 42.8 | HPV 16/18 | Histological HSIL | HSIL | Positive | HSIL | HPV 16/18 | After treatment | 3 | 4.2 |
Non-vaccinated women presenting post-treatment HSIL (n = 6) | ||||||||||
7 | 68.0 | Other HPV | HSIL in two Pap smears | HSIL | Positive | HPV | Other HPV | - | - | 6.5 |
8 | 33.0 | Other HPV | Histological HSIL | HSIL | Positive | HSIL | Other HPV | - | - | 46.1 |
9 | 55.1 | HPV 16/18 | HSIL in two Pap smears | LSIL | Negative | HSIL | HPV 16/18 | - | - | 6.3 |
10 | 26.9 | HPV 16/18 | Histological HSIL | HSIL | Positive | HPV | Negative | - | - | 10.3 |
11 | 56.5 | Other HPV | Histological HSIL | HSIL | Negative | HPV | Other HPV | - | - | 54.2 |
12 | 57.1 | Other HPV | Histological HSIL | HSIL | Negative | HPV | Other HPV | - | - | 25.4 |
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Henere, C.; Torné, A.; Llupià, A.; Aldea, M.; Martí, C.; Glickman, A.; Saco, A.; Marimon, L.; Manzotti, C.; Rakislova, N.; et al. HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions. Vaccines 2022, 10, 887. https://doi.org/10.3390/vaccines10060887
Henere C, Torné A, Llupià A, Aldea M, Martí C, Glickman A, Saco A, Marimon L, Manzotti C, Rakislova N, et al. HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions. Vaccines. 2022; 10(6):887. https://doi.org/10.3390/vaccines10060887
Chicago/Turabian StyleHenere, Carla, Aureli Torné, Anna Llupià, Marta Aldea, Cristina Martí, Ariel Glickman, Adela Saco, Lorena Marimon, Carolina Manzotti, Natalia Rakislova, and et al. 2022. "HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions" Vaccines 10, no. 6: 887. https://doi.org/10.3390/vaccines10060887
APA StyleHenere, C., Torné, A., Llupià, A., Aldea, M., Martí, C., Glickman, A., Saco, A., Marimon, L., Manzotti, C., Rakislova, N., Ordi, J., & del Pino, M. (2022). HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions. Vaccines, 10(6), 887. https://doi.org/10.3390/vaccines10060887