Associations of Cervical Vaginal Microflora with HPV Infection, Cervical Intraepithelial Neoplasia and Cancer: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 11 (02) ◽  
pp. 698-713
Author(s):  
丽 秦
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Meta Analysis ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Vaginal Microflora

scholarly journals Cervicovaginal Microbiome after Cervical Intraepithelial Neoplasia Treatment. A Protocol for Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (17) ◽  
pp. 9050
Author(s):  
Marta Janicka-Kośnik ◽  
Beata Sarecka-Hujar ◽  
Grzegorz Jakiel ◽  
Aneta Słabuszewska-Jóźwiak
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Meta Analysis ◽  
Chemical Properties ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Adverse Outcomes ◽  
Lactobacillus Species ◽  
Treatment Change ◽  
Randomized Controlled Studies

(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The cervicovaginal microbiome might contribute to the development of a persistent HPV infection—the main risk factor of cervical cancer—and influence progression to malignancy The aim is to perform a systematic review of current literature and a meta-analysis regarding microbiome changes after cervical intraepithelial neoplasia treatment. (2) Methods: We will search PubMed, Scopus, Google Scholar and Embase Database and trace citations in the reference sections. Randomized and non-randomized controlled studies, case–control and cohort studies published between January 2000 and May 2021 will be included in the study protocol. The following keywords will be used: ‘microbiome’, ‘vaginal microbiome’, ‘cervical microbiome’, ‘cervical neoplasia treatment’, ’conization’, ‘electroconization’, and ‘electrosurgical treatment’. Statistical analyses will be performed using RevMan 5.4. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: The study will show which forms of intraepithelial neoplasia treatment change the cervicovaginal microbiome. Finding the best form of treatment by studying the cervicovaginal microbiome after various forms of treatment is essential. Patients would benefit not only from the treatment of the initial disease but also the management of dysbiosis, which might underlie other pathologies.

scholarly journals Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE Group

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028008 ◽  
Author(s):  
Antonios Athanasiou ◽  
Areti Angeliki Veroniki ◽  
Orestis Efthimiou ◽  
Ilkka Kalliala ◽  
Huseyin Naci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Local Treatment ◽  
Intraepithelial Neoplasia ◽  
Risk Of Bias ◽  
Analysis Tool ◽  
Complication Rates ◽  
Meta Analyses

IntroductionLocal treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications.Methods and analysisLiterature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool.Ethics and disseminationEthical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public.PROSPERO registration numberCRD42018115508.

scholarly journals Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis

BMJ ◽  
2014 ◽  
Vol 349 (oct28 1) ◽  
pp. g6192-g6192 ◽  
Author(s):  
M. Kyrgiou ◽  
A. Mitra ◽  
M. Arbyn ◽  
S. M. Stasinou ◽  
P. Martin-Hirsch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Intraepithelial Neoplasia

scholarly journals Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review

2017 ◽  
Vol 141 (1) ◽  
pp. 8-23 ◽  
Author(s):  
Sarah R. Hoffman ◽  
Tam Le ◽  
Alexandre Lockhart ◽  
Ayodeji Sanusi ◽  
Leila Dal Santo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection

scholarly journals Comparative fertility and pregnancy outcomes after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE group

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e028009 ◽  
Author(s):  
Antonios Athanasiou ◽  
Areti Angeliki Veroniki ◽  
Orestis Efthimiou ◽  
Ilkka Kalliala ◽  
Huseyin Naci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Cervical Intraepithelial Neoplasia ◽  
Pregnancy Outcomes ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Local Treatment ◽  
Intraepithelial Neoplasia ◽  
Risk Of Bias ◽  
Treatment Comparison

IntroductionThere are several local treatment methods for cervical intraepithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth (PTB) and that this is higher for techniques that remove larger parts of the cervix, although the data are conflicting. We present a protocol for a systematic review and network meta-analysis (NMA) that will update the evidence and compare all treatments in terms of fertility and pregnancy complications.Methods and analysisWe will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes among different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be PTB (<37 weeks). Secondary outcomes will include severe or extreme PTB, prelabour rupture of membranes, low birth weight (<2500 g), neonatal intensive care unit admission, perinatal mortality, total pregnancy rates, first and second trimester miscarriage. We will search for published and unpublished studies in electronic databases, trial registries and we will hand-search references of published papers. We will assess the risk of bias in RCTs and cohort studies using tools developed by the Cochrane collaboration. Two investigators will independently assess the eligibility, abstract the data and assess the risk of bias of the identified studies. For each outcome, we will perform a meta-analysis for each treatment comparison and an NMA once the transitivity assumption holds, using the OR for dichotomous data. We will use CINeMA (Confidence in Network meta-analysis) to assess the quality of the evidence for the primary outcome.Ethics and disseminationEthical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.PROSPERO registration numberCRD42018115495

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