Heterogeneity in Risk of Recurrent CIN2+ Among Women With Genotype-Specific HPV Detected After Excision: A Cohort Study.

OBJECTIVE: To evaluate the recurrence of cervical intraepithelial neoplasia grade 2 or worse or carcinoma (CIN2+) after conization by post-treatment human papillomavirus (HPV) genotype, timing of HPV detection, and cone margin status. MATERIALS AND METHODS: We analyzed a retrospective cohort of unvaccinated women treated by conization for CIN2+ or carcinoma (2010-2024) with HPV genotyping performed more than 4 months after excision. Results were categorized as HPV16, HPV18, another 12 high-risk types pooled (hrHPV), or negative, and as early (4-12 mo) or late (>12 mo) after conization. Recurrence was histologically confirmed, and adjusted incidence rate ratios (aIRRs) were estimated using Poisson regression. RESULTS: Among 2,628 women with genotyping, early HPV16 detection had the highest CIN2+ recurrence rate, 294 per 1,000 person-years (py). Compared with early HPV16, recurrence was lower among women with the other 12 hrHPV types pooled (34 per 1,000 py; aIRR: 0.13; 95% CI: 0.06-0.26) and among those with HPV-negative results (2 per 1,000 py; aIRR: 0.01; 95% CI: 0.00-0.02). With late detection, recurrence remained highest among women with HPV16 positivity (321 cases per 1,000 py), whereas the recurrence rate associated with the pooled other 12 hrHPV genotypes was twice as high as that observed with early detection (74 cases per 1,000 py). Positive margins were associated with higher recurrence risk, primarily among women with early post-excision HPV positivity. CONCLUSIONS: Post-treatment HPV genotyping reveals marked heterogeneity in CIN2+ recurrence risk. This pattern may improve risk-stratified screening and may help interpret recurrence reductions reported after HPV16-containing vaccination.