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. 2025 May 19;25(1):885.
doi: 10.1186/s12885-025-14138-4.

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

Kexin Li  1 , Fanwei Huang  1 , Tao Zhang  1 , Fan Yang  2 , Weitao Duan  2 , Shimin Chen  2 , Ting Hu #  3   4 , Xiaoyuan Huang #  5   6
Affiliations

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

Kexin Li et al. BMC Cancer. .

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.

Keywords: Follow-up.; HPV integration; Human papillomavirus; Risk stratification.

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Conflict of interest statement

Declarations. Patient consent for publication: All authors are in agreement with the content of the manuscript. Informed consent: Patient consent was waived by the Ethics Committee of Tongji Hospital of Huazhong University of Science and Technology. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of study enrollment. Abbreviations: CIN2, cervical intraepithelial neoplasia grade 2; CIN3+, cervical intraepithelial neoplasia grade 3 or worse; HPV, Human papillomavirus
Fig. 2
Fig. 2
The immediate risk of CIN2 + and CIN3 + and the 1-year cumulative risk of CIN2 + and CIN3 + at different number of HPV integration reads. Abbreviations: CIN2+, cervical intraepithelial neoplasia grade 2 or worse; CIN3+, cervical intraepithelial neoplasia grade 3 or worse; HPV, Human papillomavirus. The dashed line corresponds to the treatment referral threshold
Fig. 3
Fig. 3
The 1-year outcomes of HPV integration-positive women at different integration reads Abbreviations: CIN2+, cervical intraepithelial neoplasia grade 2 or worse; HPV, Human papillomavirus
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