Risk of 3-Year Cytological Progression by Baseline HPV Status Among Women With Normal Cytology: A Multicenter Cohort...

Tailored cervical cancer screening strategies are essential, particularly in resource-limited settings. This study aimed to assess the genotype-specific impact of high-risk human papillomavirus (HR-HPV) infections on cervical cytological progression over a 3-year interval among Chinese women, thereby providing evidence for more precise and individualized screening approaches. A multicenter cohort was established in 2017 across three Chinese provinces. Participants underwent baseline HPV genotyping and cytological examination, with genotyping for five high-risk types (HPV16, 18, 33, 52, and 58), and follow-up evaluations conducted from 2018 to 2020. Cytological progression was defined as a transition from normal cytology (negative for intraepithelial lesion or malignancy, NILM) at baseline to low-grade squamous intraepithelial lesion (LSIL) or worse at the final follow-up. A total of 7240 women were included to evaluate the cytological progression. The overall progression rate was 0.7%, with a notably higher rate among HR-HPV-positive women (2.1%) compared to HR-HPV-negative women (0.5%). Specifically, HPV16, HPV52, and HPV58 were significantly associated with an increased risk of progression, with adjusted odds ratios (aORs) of 6.26 (95% CI: 2.62-14.95), 6.68 (95% CI: 3.30-13.53), and 4.24 (95% CI: 1.51-11.94), respectively. Moreover, women with persistent infections with HPV16, HPV52, and HPV58 had approximately 8-fold, 6-fold, and 5-fold higher risks of progression, respectively, compared with women without infections. Stratified management based on high-risk genotypes-particularly HPV16, HPV52, and HPV58-may help prioritize colposcopy and more intensive follow-up for women at elevated risk, which could contribute to cervical cancer prevention efforts. Trial Registration: Chinese Clinical Trial Registry Center of the World Health Organization International Clinical Trials Registry Platform number: ChiCRT2200055287.