Reduced risk of CIN2+ recurrence in women immunized with a 9-valent HPV vaccine post-excision: Retrospective cohort study

ABSTRACT

The main aim of our study was to investigate the specific contribution of a 9-valent human papillomavirus vaccine (9vHPV) to the recurrence risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women vaccinated post-excision. Therefore, we conducted a retrospective monocentric cohort study in women aged 22–49 years undergoing conization between 2014 and 2023. The 9vHPV-vaccinated women were matched to unvaccinated women for age and follow-up duration in a 1:2 ratio to eliminate allocation bias. The risk of CIN2+ recurrence was estimated by the incidence rate ratio using Poisson regression with adjustment for comorbidities, smoking status, nulliparity, CIN grade, positive cone margin, and HPV genotypes. The CIN2+ recurrence rates in 147 women enrolled in the analysis were 18 and 2 cases per 100,000 person-days for unvaccinated and vaccinated women, respectively, during a mean follow-up period of 30 months (±22 months). A reduction in CIN2+ recurrences by 90% (95% confidence interval: 12–99%) was documented in 9vHPV-vaccinated participants compared to women undergoing only surgical excision. Moreover, vaccinated women with a positive cone margin showed a 42% (though non-significant) reduction in relapse (p = .661). Full post-conization vaccination with the 9vHPV contributed to an additional reduction in the risk of CIN2+ recurrence. This finding is consistent with current knowledge and suggests a high adjuvant effect of the 9vHPV vaccine.

KEYWORDS:

• Human papillomavirus
• cervical intraepithelial neoplasia
• conization
• vaccination
• recurrence reduction

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions statement

The study was conceived by MP and designed by MP, IKL, and PD. The data were acquired and collated by VDjr, VD, and DL, and analyzed by MP. Funding was arranged by PD. Administrative and material support was negotiated by VDjr. and RP. The manuscript was drafted and revised critically for important intellectual content by all authors (VDjr, MP, VD, DL, PD, IKL, and RP). All authors gave final approval of the version to be published. MP, VDjr, and VD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2024.2343552.

Additional information

Funding

This work was supported by the Cooperation 31 fund, Health Sciences, Charles University, Prague, Czech Republic. The fund had no role in the study design, data analysis, data interpretation, or writing of this report.