Early and long-term effects of prophylactic and post-excision human papillomavirus vaccination on recurrent high-grade cervical intraepithelial neoplasia relative to margin status: a retrospective cohort study in the Czech Republic

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F25%3A43928566" target="_blank" >RIV/00064173:_____/25:43928566 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/68407700:21460/25:00389689 RIV/00216208:11110/25:10498648 RIV/00216208:11120/25:43928566 RIV/61989592:15110/25:73631311 a 2 dalších

Výsledek na webu

<a href="https://doi.org/10.1016/j.lanepe.2025.101337" target="_blank" >https://doi.org/10.1016/j.lanepe.2025.101337</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.lanepe.2025.101337" target="_blank" >10.1016/j.lanepe.2025.101337</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Early and long-term effects of prophylactic and post-excision human papillomavirus vaccination on recurrent high-grade cervical intraepithelial neoplasia relative to margin status: a retrospective cohort study in the Czech Republic

Popis výsledku v původním jazyce

Background: The effect of human papillomavirus (HPV) vaccination on cervical intraepithelial neoplasia grade 2 or worse (CIN2+) recurrence with respect to cone margin positivity is unknown. Most studies assessed this effect beyond two months post-conisation. We aimed to determine both the duration and early onset of effect in women who had been prophylactically vaccinated or vaccinated after conisation, considering cone margin status. Methods: This cohort study used data from one of the central laboratories in the Czech Republic, covering approximately 33% of women undergoing national cervical cancer screening. It included women treated for CIN2+ between 2010 and 2024 who had received either prophylactic HPV vaccination (available through the national immunisation program since 2011) or post-conisation vaccination (recommended by the Czech Gynaecological and Obstetrical Society since 2008). The vaccination effect was estimated using the incidence rate ratio (IRR) from a Poisson regression model, calculated as 100 x (1-IRR). Findings: Of the 10,054 women enrolled, 919 were vaccinated after conisation, 502 prophylactically, and 169 had undetermined timing of vaccination. Throughout the follow-up period, CIN2+ recurrence was observed in 513 unvaccinated women, with a rate of 14.61 per 1000 person-years (py), in 14 prophylactically vaccinated women, with a rate of 5.84 (54% reduction; 95% confidence interval [CI]: 22-73%), and in 15 women vaccinated post-excision, with a rate of 3.37 (74% reduction; 95% CI: 57-85%). The high recurrence rate of 58.59 per 1000 py within six months of conisation was reduced by 80% (95% CI: 19-95%) with prophylactic vaccination and by 89% (95% CI: 57-97%) with incomplete post-excision vaccination. Among a total of 1771 women with a positive cone margin, recurrence was identified in 272 of 1568 unvaccinated women, corresponding to a recurrence rate of 51.62 per 1000 py. A reduction was observed in 84 prophylactically vaccinated and in 119 women vaccinated post-excision, with only 6 recurrence cases documented in each group. This corresponded to recurrence rates of 14.94 (62% reduction; 95% CI: 14-83%) and 9.78 per 1000 py (79% reduction; 95% CI: 52-90%), respectively. Interpretation: Regardless of timing, HPV vaccination has a beneficial long-term effect in lowering the risk of CIN2+ recurrence. Despite the greater reduction in relapse achieved by post-excision vaccination, the difference compared with the prophylactic one was not statistically significant. The most pronounced benefit was observed within the first six months post-conisation, particularly in women with a positive cone margin.

Název v anglickém jazyce

Early and long-term effects of prophylactic and post-excision human papillomavirus vaccination on recurrent high-grade cervical intraepithelial neoplasia relative to margin status: a retrospective cohort study in the Czech Republic

Popis výsledku anglicky

Background: The effect of human papillomavirus (HPV) vaccination on cervical intraepithelial neoplasia grade 2 or worse (CIN2+) recurrence with respect to cone margin positivity is unknown. Most studies assessed this effect beyond two months post-conisation. We aimed to determine both the duration and early onset of effect in women who had been prophylactically vaccinated or vaccinated after conisation, considering cone margin status. Methods: This cohort study used data from one of the central laboratories in the Czech Republic, covering approximately 33% of women undergoing national cervical cancer screening. It included women treated for CIN2+ between 2010 and 2024 who had received either prophylactic HPV vaccination (available through the national immunisation program since 2011) or post-conisation vaccination (recommended by the Czech Gynaecological and Obstetrical Society since 2008). The vaccination effect was estimated using the incidence rate ratio (IRR) from a Poisson regression model, calculated as 100 x (1-IRR). Findings: Of the 10,054 women enrolled, 919 were vaccinated after conisation, 502 prophylactically, and 169 had undetermined timing of vaccination. Throughout the follow-up period, CIN2+ recurrence was observed in 513 unvaccinated women, with a rate of 14.61 per 1000 person-years (py), in 14 prophylactically vaccinated women, with a rate of 5.84 (54% reduction; 95% confidence interval [CI]: 22-73%), and in 15 women vaccinated post-excision, with a rate of 3.37 (74% reduction; 95% CI: 57-85%). The high recurrence rate of 58.59 per 1000 py within six months of conisation was reduced by 80% (95% CI: 19-95%) with prophylactic vaccination and by 89% (95% CI: 57-97%) with incomplete post-excision vaccination. Among a total of 1771 women with a positive cone margin, recurrence was identified in 272 of 1568 unvaccinated women, corresponding to a recurrence rate of 51.62 per 1000 py. A reduction was observed in 84 prophylactically vaccinated and in 119 women vaccinated post-excision, with only 6 recurrence cases documented in each group. This corresponded to recurrence rates of 14.94 (62% reduction; 95% CI: 14-83%) and 9.78 per 1000 py (79% reduction; 95% CI: 52-90%), respectively. Interpretation: Regardless of timing, HPV vaccination has a beneficial long-term effect in lowering the risk of CIN2+ recurrence. Despite the greater reduction in relapse achieved by post-excision vaccination, the difference compared with the prophylactic one was not statistically significant. The most pronounced benefit was observed within the first six months post-conisation, particularly in women with a positive cone margin.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30303 - Infectious Diseases

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Lancet Regional Health - Europe

ISSN

2666-7762

e-ISSN

2666-7762

Svazek periodika

55

Číslo periodika v rámci svazku

August

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

12

Strana od-do

101337

Kód UT WoS článku

001504844700001

EID výsledku v databázi Scopus

2-s2.0-105007113564