HPV integration status conversion and CIN2 + cancer risk stratification based on HPV integration levels among HPV integration-positive women: a 1-year follow-up study

Abstract

Background: HPV integration is a crucial genetic step in cervical carcinogenesis and the level of HPV integration increases with the grade of precancerous lesion. This study aimed to conduct risk stratification based on HPV integration levels and HPV integration status conversion among HPV integration-positive women after 1 year of follow-up. Methods: This prospective cohort study was conducted in Tongji Hospital between June 2020 and August 2022 and included 1297 consecutive HPV-positive women. The level of integration reads was stratified for risk assessment. Results: In total, 194 women were HPV integration-positive and followed for at least 1 year. The immediate risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) increased from 36.2% (25/69) among women with 6–20 integration reads to 93.8% (30/32) among women with more than 1000 integration reads (Ptrend < 0.001). The 1-year cumulative risk of CIN2 + increased from 39.1% (27/69) among women with 6–20 integration reads to 96.9% (31/32) among women with more than 1000 integration reads (Ptrend < 0.001). The 1-year cumulative risk of CIN2 + with HPV integration reads more than 40 was 93.8% (90/96), which was significantly higher than that of HPV integration reads less than 40 (38/85, P < 0.001). Among women with HPV integration reads more than 40, 99.0% (95/96) of women progressed with positive outcomes after one year of follow-up (persistent integration at the same site, immediate CIN2+, and 1-year CIN2+). The progression rate of women with persistent integration at the same site was 41.6% (5/12), which was significantly higher than those of HPV integration-negative conversion (0/41, 0%, P < 0.001). Conclusion: The number of HPV integration reads may help CIN2 + risk stratification and facilitate the clinical management of high-risk patients.