Background: Conservative management of grade 2 cervical intraepithelial neoplasia (CIN2) is now supported by international guidelines, especially in young women or those seeking fertility. However, identifying subgroups at increased risk of progression remains a clinical priority, especially in settings with prolonged surveillance. Objectives: To evaluate the clinical evolution of CIN2 in an HPV-positive cohort followed under active surveillance for a maximum follow-up of 48 months, with particular attention to the risk of progression, persistence and regression, and associated predictors. Methods: Retrospective observational study conducted on a cohort of 237 HPV-positive women with a histological diagnosis of CIN2. Three possible clinical outcomes (progression, persistence, and regression) were analyzed. Patients underwent structured follow-up including cytology and colposcopy every 6 months, and HPV testing annually. Excisional treatment was performed only in case of progression or poor compliance. Logistic regression (univariate and multivariate) was applied to identify independent predictors of progression and regression. Results: After a maximum follow-up of 48 months. 61.3% of lesions regressed spontaneously, 13.1% persisted, and 25.5% progressed to CIN3. In multivariate analysis, high-grade cytology (ASC-H/HSIL) and HPV 16/18 infection were independently associated with a reduced likelihood of regression (OR ≈ 0.5,p< 0.01) and an increased risk of progression (OR ≈ 2.0,p< 0.05). Lesion size and age were not significant predictors. Importantly, no invasive carcinoma occurred during follow-up. Conclusions: Active surveillance for CIN2 remains a valid strategy in low-risk subgroups, but it is not universally safe. Data suggest that the combination of high-grade cytology and HPV 16/18 represents a high oncological risk profile, for which prompt treatment is indicated. Persistence beyond 36 months should be considered a cumulative risk marker, with implications for personalized follow-up and risk management. Further prospective, registry-linked studies are required to validate long-term safety and refine risk-based management strategies for CIN2.
背景：目前国际指南支持对2级宫颈上皮内瘤变（CIN2）采取保守管理策略，尤其适用于年轻女性或有生育需求的患者。然而，识别进展风险较高的亚组仍是临床优先事项，特别是在需要长期监测的情况下。目的：评估HPV阳性队列中CIN2的临床转归，该队列接受最长48个月的主动监测随访，重点关注病变进展、持续存在及消退的风险及其相关预测因素。方法：对237例经组织学诊断为CIN2的HPV阳性女性进行回顾性观察研究。分析三种可能的临床结局（进展、持续存在和消退）。患者接受结构化随访，包括每6个月进行细胞学和阴道镜检查，每年进行HPV检测。仅在发生进展或依从性差时实施切除治疗。采用逻辑回归（单变量和多变量）分析确定进展和消退的独立预测因素。结果：在最长48个月的随访期内，61.3%的病变自发消退，13.1%持续存在，25.5%进展为CIN3。多变量分析显示，高级别细胞学（ASC-H/HSIL）和HPV 16/18感染与消退可能性降低（OR≈0.5，p<0.01）及进展风险增加（OR≈2.0，p<0.05）独立相关。病变大小和年龄并非显著预测因素。值得注意的是，随访期间未发生浸润性癌。结论：对低风险亚组的CIN2进行主动监测仍是有效策略，但并非普遍安全。数据表明，高级别细胞学联合HPV 16/18感染代表高肿瘤风险特征，需及时治疗。病变持续存在超过36个月应被视为累积风险标志，对个体化随访和风险管理具有指导意义。需要进一步开展前瞻性、基于登记的研究，以验证CIN2长期管理的安全性，并完善基于风险的分层管理策略。
CIN2 and Active Surveillance: Evidence from 48-Month Follow-Up in an HPV-Positive Cohort
肿瘤(癌症)患者之家