ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Integrating active surveillance and HPV Vaccination for High-Risk CIN2: A Strategy to Reduce Disease Progression
Kaiyang Geng 1
Siyu Bai 2
Ruizhen Liu 2
Longyu Jia 2
Yan Zhai 1
Zhihua Sun 3
Ruili Jiao 3
Xue Li 1
Jun Liu 1
Huimin Bai 2,1
1. Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
2. Beijing Fuxing Hospital, Beijing, China
3. Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, China., Beijing, China
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Abstract
Objective: To identify risk factors associated with disease progression in women with cervical intraepithelial neoplasia grade 2 (CIN2) undergoing active surveillance and to evaluate the protective effect of human papillomavirus (HPV) vaccination administered after diagnosis. Methods: This single-center, retrospective cohort study included 510 women (mean age 30.15 ± 5.82 years, range 18-61) with histologically confirmed CIN2 who chose active surveillance between January 2012 and March 2021. Patient demographics, clinical characteristics, and HPV vaccination status were collected and analyzed. Primary and secondary outcomes were complete regression, persistence, and progression of disease (to CIN3, adenocarcinoma in situ [AIS], or invasive cancer). Univariate and multivariate logistic regression analyses, along with Cox proportional hazards models, were applied to assess risk factors. Results: Over a mean follow-up period of 37.0 months, 65.9% (336/510) of patients achieved complete regression, 10.8% (55/510) exhibited persistent CIN2, and 6.3% (32/510) experienced disease progression. Multivariate analysis identified HPV16 infection (OR 4.07, 95%CI 1.88–8.81) and having more than three pregnancies (OR 4.38, 95%CI 1.63–11.79) as independent risk factors for progression. Notably, HPV vaccination administered after CIN2 diagnosis was found to be an independent protective factor (OR 0.29, 95%CI 0.08–0.98). The Kaplan-Meier estimated 5-year progression rate was 72% (5 of 13 patients) in the high-risk subgroup (unvaccinated, HPV16-positive women with more than three pregnancies), compared with only 7.6% (27 of 497 patients) in the low-risk subgroup (vaccinated, HPV16-negative women with three or fewer pregnancies). Conclusion: Active surveillance is a safe and effective management strategy for most women with CIN2. Risk stratification using HPV16 infection status and pregnancy history is crucial for personalized management. HPV vaccination after CIN2 diagnosis is strongly recommended, as it significantly reduces the risk of disease progression.
Summary
Keywords
active surveillance, Cervical Intraepithelial Neoplasia grade 2 (CIN2), disease progression, HPV16, Human papillomavirus (HPV) vaccination, risk stratification
Received
14 December 2025
Accepted
19 February 2026
Copyright
© 2026 Geng, Bai, Liu, Jia, Zhai, Sun, Jiao, Li, Liu and Bai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jun Liu; Huimin Bai
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