Effect of prophylactic HPV vaccination and timing of administration on recurrence of cervical HSIL after LEEP: A retrospective study

The objective of this study was to identify risk factors for recurrent cervical high-grade squamous intraepithelial lesions (HSIL/CIN2-3) following loop electrosurgical excision procedure (LEEP), with a particular focus on evaluating the protective effect of human papillomavirus (HPV) vaccination, including effective timing of administration, against disease recurrence. This retrospective study analyzed 343 patients with colposcopy-directed biopsy-confirmed cervical HSIL who underwent LEEP, including 127 vaccinated and 216 unvaccinated individuals. Multivariate logistic regression analysis was employed to identify risk factors associated with HSIL recurrence. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff timing of HPV vaccination for preventing post-LEEP HSIL recurrence. Among the 343 patients, the post-LEEP HSIL recurrence rate was 9.0%. Multivariate logistic analysis identified CIN3 (OR = 2.956, 95% CI 1.046–8.352, P = .041), glandular involvement (OR = 3.517, 95% CI 1.165–10.621, P = .026), positive margins (OR = 2.496, 95% CI 1.100–5.667, P = .029), and persistent HPV infection (OR = 6.253, 95% CI 2.043–19.135, P = .001) as independent risk factors for HSIL recurrence. HPV vaccination was associated with a lower risk of HSIL recurrence (OR = 0.249, 95% CI 0.082–0.760, P = .015). ROC analysis indicated that administration of the HPV vaccine within 6 months post-LEEP was the optimal cutoff time for preventing recurrence (AUC = 0.851, P = .017). Vaccination either before LEEP or within this 6-month postoperative period significantly reduced the risk of HSIL recurrence ( P = .034). CIN3, gland involvement, positive margins, and persistent HPV infection increase the risk of cervical HSIL recurrence after LEEP. HPV vaccination, when administered either before or within 6 months after LEEP, is associated with a lower risk of cervical HSIL recurrence.