Pro metastatic gene expression, immune evasion and an altered HPV spectrum characterize an aggressive subtype of cervical cancer

Cervical cancer is caused by carcinogenic human papillomavirus infection and represents one of the leading causes of cancer death worldwide. Effective means of tumour classification are required for better disease understanding. We performed an integrated multi-omic analysis of 655 cervical cancers, using epigenomic and transcriptomic signatures to discover two distinct cervical cancer subtypes we named typical and atypical. Typical tumours were largely HPV16-driven and frequently displayed an immune-hot tumour microenvironment. Atypical tumours were associated with poor prognosis; they were more likely to be driven by HPVs from the HPV18-containing α7 clade, displayed distinct genomic aberrations, greater evidence of past immunoediting and a microenvironment associated with immune-evasion and failure of anti-PD1 checkpoint inhibition. The finding that atypical tumours encounter stronger anti-tumour immune responses during development may explain the lower frequency at which α7 HPV infected-lesions progress from pre-invasive disease. However those escaping this selection pressure evolve into aggressive tumours (independent of HPV-type) in which more intensive adjuvant treatment may be warranted.