小柯机器人

英国盖伊医院Peter Sasieni团队研究了英国国家HPV疫苗接种计划对宫颈癌和3级宫颈上皮内瘤变发病率的影响。相关论文发表在2021年11月3日出版的《柳叶刀》杂志上。

2008年9月1日，英国引入了使用人乳头瘤病毒（HPV）二价疫苗（Cervarix）的免疫接种：2008-10年为12-13岁的女孩提供了常规疫苗接种，并为14-18岁的女性提供了一个补种计划。研究组量化了该免疫方案对宫颈癌和原位宫颈癌（即3级宫颈上皮内瘤变（CIN3））登记的早期影响。

在这项观察性研究中，研究组使用年龄-周期队列泊松模型的扩展来估计三个接种疫苗的队列与不符合HPV疫苗接种条件的早期队列间宫颈癌的相对风险。2021年1月26日研究组提取了基于人群的癌症登记数据，并从2006年1月1日至2019年6月30日对20-64岁的英国居民妇女进行了宫颈癌和CIN3诊断评估。研究组使用了三个接种过疫苗的队列，以说明提供疫苗的学年及其全国覆盖率的差异。利用影响宫颈癌发病率的宫颈筛查政策变化和历史事件的信息对混杂因素进行校正。在不同混杂因素校正的模型间比较结果。

研究组使用了总计1370万人-年的20岁至30岁以下女性的随访数据。与未接种疫苗的参考队列相比，16-18岁（12-13学年）、14-16岁（10-11学年）和12-13岁（8学年）的宫颈癌发病率估计分别相对降低34%、62%和87%。16-18岁年龄组的CIN3的相应风险降低39%，14-16岁年龄组降低75%，12-13岁年龄组降低97%。这些结局在不同模型中保持相似。研究组估计，到2019年6月30日，英国接种疫苗队列中宫颈癌比预期减少448例，CIN3减少17235例。

研究结果表明，在英国引入HPV免疫接种计划后，年轻女性宫颈癌和CIN3发病率显著降低，尤其是在12-13岁接种疫苗的个体中。HPV免疫计划几乎成功地消除了1995年9月1日后出生女性的宫颈癌。

附：英文原文

Title: The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study

Author: Milena Falcaro, Alejandra Castaon, Busani Ndlela, Marta Checchi, Kate Soldan, Jamie Lopez-Bernal, Lucy Elliss-Brookes, Peter Sasieni

Issue&Volume: 2021-11-03

Abstract:

Background

Human papillomavirus (HPV) immunisation with a bivalent vaccine (Cervarix) was introduced in England, UK, in Sept 1, 2008: routine vaccination was offered to girls aged 12–13 years with a catch-up programme for females aged 14–18 years in 2008–10. We quantified the early effect of this immunisation programme on cervical cancer and cervical carcinoma in situ, namely grade 3 cervical intraepithelial neoplasia (CIN3), registrations.

Methods

In this observational study, we used an extension of the age-period-cohort Poisson model to estimate the relative risk of cervical cancer in three vaccinated cohorts compared with earlier cohorts that were not eligible for HPV vaccination. Data from a population-based cancer registry were extracted on Jan 26, 2021, and were assessed for diagnoses of cervical cancer and CIN3 from Jan 1, 2006 to June 30, 2019 in women aged 20–64 years and who were a resident in England. We used three vaccinated cohorts to account for differences in the school year in which the vaccine was offered and its national coverage. Adjustment for confounding was made using information on changes in cervical screening policy and historical events that affected cervical cancer incidence. Results were compared across models with different adjustments for confounders.

Findings

We used data from a total of 13·7 million-years of follow-up of women aged 20 years to younger than 30 years. The estimated relative reduction in cervical cancer rates by age at vaccine offer were 34% (95% CI 25–41) for age 16–18 years (school year 12–13), 62% (52–71) for age 14–16 years (school year 10–11), and 87% (72–94) for age 12–13 years (school year 8), compared with the reference unvaccinated cohort. The corresponding risk reductions for CIN3 were 39% (95% CI 36–41) for those offered at age 16–18 years, 75% (72–77) for age 14–16 years, and 97% (96–98) for age 12–13 years. These results remained similar across models. We estimated that by June 30, 2019 there had been 448 (339–556) fewer than expected cervical cancers and 17235 (15 919–18 552) fewer than expected cases of CIN3 in vaccinated cohorts in England.

Interpretation

We observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12–13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995.

DOI: 10.1016/S0140-6736(21)02178-4

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02178-4/fulltext

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