A Meta Analysis Of The Efficacy Of HPV Vaccine In Cervical Cancer

Background and Objective: Cervical cancer is the second largest killer for womenmalignant tumors，which is harm to women health and life safety, there are about2.7billionpeople die from cervical cancer and related complications each year worldwide.High-riskhuman papilloma virus persistent infection is one of the main reasons for development ofcervical lesions, worldwide HPV16and HPV18infection accounted for70%of the totalcorrelation of HPV cervical lesions.Now bivalent and quadrivalent cervical cancer vaccinehave appeared, and foreign large-scale randomized double-blind controlled clinical trials toexplore the effectiveness of the cervical cancer vaccine safety have pointed out the directionof primary prevention for cervical cancer. The purpose of this paper is to analysis the theefficacy of HPV vaccine in prevention for HPV persist infection about six months，CINthrough meta analysis.Methods:(1) Experimental research design: computer retrieval between January2000and November2013about human papilloma virus (HPV) vaccine to prevent HPV persistent infection andrandomized controlled trial study of cervical lesions.(2) The research object (participants): healthy non-pregnant women. Age between12years old and25years old. Any subjects ethnic nationality.(3) Interventions (interventions): the experimental group subjects receiving HPVprophylactic vaccines.(4) Comparisons (comparisons): with the subjects received placebo or other vaccines forcomparison.(5)Outcomes (outcomes):(1) persistent HPV infection, HPV infection persists for more than6months or more).(2) the cervical intraepithelial neoplasia grade Ⅰ (CINⅠ) and theincidence of the above.(3) the cervical intraepithelial neoplasia grade Ⅱ (CINⅡ) and aboverates.After the selected literature to extract data application RevMan5.2meta analysis software.Results:1. A meta-analysis of HPV vaccine efficacy in preventing HPV16persist for6months, thereare5studies included, a total of17815participants.8893in the intervention group and8883in the control. Intervention group and control group for six months the relative risk ofinfection as shown in figure4.1(a). The heterogeneity inspection results suggest P=0.97, I2=0%, using fixed effect model, consolidated relative risk0.05, namely the vaccine efficacywas95%, CI for [0.03,0.09]. In the figure4.1(a) the forest figure shows the confidenceinterval of the study are not including0, indicates that the effect of volume in the researchhave statistical significance, Z=10.61(P <0.00001), indicating that human papilloma virus vaccine has prevention effect to HPV16for6months of persistent infection. Funnel graph inthe figure4.1(b) graph is symmetrical, suggests that there is no publication bias.2. A meta-analysis of HPV vaccine efficacy in preventing HPV18persist for6months, thereare3studies included, a total of13921people. Including6967people in the interventiongroup and control group of6954people. Intervention group and control group HPV18infection for six months of relative risk as shown in figure4.2(a). The heterogeneityinspection results suggest P=0.51, I2=0%, using fixed effect model, consolidated relativerisk0.22, namely the vaccine efficacy was78%, CI for [0.13,0.39]. In the figure4.2(a) theforest figure shows the diamond completely is located in the center, Z=5.51(P <0.00001),indicating that human papilloma virus vaccine of HPV18is dffective in six months ofpersistent infection prevention. Funnel graph in the figure4.2(b) graph is symmetrical,suggests that there is no publication bias.3. A meta-analysis of HPV vaccine efficacy in preventing cervical intraepithelial neoplasiagrade I，there are8references included. Participants in a total of26601people，13290in theintervention group and13311in the control. The relative risk as is shown in figure4.3.1(a).The heterogeneity inspection results suggest P=0.02, I2=58%, using random effects model,consolidated relative risk0.18, namely the vaccine efficacy was82%, CI for [0.08,0.37]. Inthe figure4.3.1(a) the forest figure shows the diamond completely is locatedin the center, Z=4.64(P <0.00001), indicating that human papilloma virus vaccine for CINI level andabove disease prevention effects. Funnel graph in the figure4.3.1(b) is symmetrical, tsuggests that there is no publication bias.4. A meta-analysis of the bivalent human papilloma virus vaccine effectiveness forpreventing cervical intraepithelial neoplasia of grade I, a total number of20222in4researches, including10114people in the intervention group and10108in the control.Theheterogeneity inspection results suggest P=0.12, I2=49%, using fixed effect model,consolidated relative risk0.34, namely the vaccine efficacy was66%, CI for [0.28,0.42].Graphic4.3.2.1forest (a) shows the diamond completely is located in the center, Z=10.54(P <0.00001), indicating that bivalent human papilloma virus vaccine for preventingcervical intraepithelial neoplasia grade I and above is effective. Graphic4.3.2.1(b) funnelpoor figure is symmetrical, there is no publication bias.5. A meta-analysis of the quadrivalent human papilloma virus vaccine effectiveness forpreventing cervical intraepithelial neoplasia of grade I and above, a total number of6379in4studies,3176people in the intervention group and3203in the control group. Theheterogeneity inspection results suggest P=0.46, I2=0%, using fixed effect model,consolidated relative risk0.09, namely the vaccine efficacy was91%, CI for [0.04,0.21].Graphic4.3.2.2forest (a) shows the diamond completely is located in the center, Z=5.57(P<0.00001), indicating that quadrivalent human papilloma virus vaccine for preventingcervical intraepithelial neoplasia grade I and above is effective. Graphic4.3.2.2figure (b) afunnel is symmetrical, there is no publication bias.6. A meta-analysis of Human papillomavirus vaccine for preventing cervical intraepithelialneoplasia grade Ⅱ. Participants in a total of75490people in11studies. Including37727 people in the intervention group and37763in the control.Meta analysis results is shown in4.4.1(a), heterogeneity inspection results suggest P <0.00001, I2=82%, show the obviousheterogeneity between studies, using random effects model, consolidated, relative risk was0.07, the vaccine efficacy was93%, the confidence interal [0.02,0.02]. Graphic4.4.1forest(a) shows the diamond completely is located in the center, Z=4.73(P <0.00001), indicatingthat human papilloma virus vaccine prevention against the incidence of CINⅡ level andabove is effective. Graphic4.4.1figure (b) a funnel is symmetrical, explain the existence ofresearch data is not publication bias.7. A meta-analysis of bivalent human papilloma virus vaccine against cervical intraepithelialneoplasia grade CINⅡ and above, a total number of53471in6articles, including26733people in the intervention group and26738in the control.The heterogeneity inspectionresults suggest P <0.00001, I2=87%, using random effects model, consolidaed, relative risk0.09, namely the vaccine efficacy was91%, the confidence interal [0.042,0.38]. Graphic4.4.2.1(a) forest shows the diamond completely is located in the center, Z=3.32(P=0.0009), indicating that bivalent human papilloma virus vaccine prevention against theincidence of CINⅡ level and above is effective. Graphic4.4.2.1(b)figure the funnel issymmetrical,there is no publication bias.8. A meta-analysis of the quadrivalent human papilloma virus vaccine effectiveness forpreventing cervical CINⅡ+,a total number of22019in5articles,10994people in theintervention group and11025in the control.The heterogeneity inspection results suggest P=0.84, I2=0%, using fixed effect model, consolidated relative risk0.04, namely the vaccineefficacy was96%, CI for [0.01,0.11]. Graphic4.4.2.2forest (a) shows the diamond islocated in the center, Z=5.96(P <0.00001), suggesting that the quadrivalent humanpapilloma virus vaccine for againsting cervical intraepithelial neoplasia grade Ⅱ and aboveis effective. Graphic4.4.2.2(b) funnel is symmetrical, there is no publication bias.Conclusion1. HPV prophylactic vaccine can reduce the risk of HPV16and HPV18persist infection.2.The HPV prophylactic vaccine can reduce the risk of CINI and above cervical diseaseprevalence.3.The HPV prophylactic vaccine can reduce the risk of CINⅡ and above the cervical diseaseprevalence.