A meta-analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale.
A meta-analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale.
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DOI：
10.1002/ijc.33185
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发表时间：
2021-01-01
影响因子：
6.4
通讯作者：
Stier EA
中科院分区：
文献类型：
--
作者：
Clifford GM;Georges D;Shiels MS;Engels EA;Albuquerque A;Poynten IM;de Pokomandy A;Easson AM;Stier EA
已知某些人群的肛门癌风险高于平均水平，即艾滋病毒携带者(PLHIV)、男男性行为者(MSM)、被诊断为感染了人类乳头瘤病毒(HPV)相关的妇科癌前病变或癌症的女性、实体器官移植接受者和自身免疫性疾病患者。我们的目标是为这些人群的肛门癌负担提供可靠和可比的估计。采用固定效应荟萃分析计算总发病率(以每10万 ，000人年发病数为单位)。HIV阳性男男性接触者(n=7)的 为85(95%可信区间=82-89)，男性非HIV感染者(n=5)的IR为32(95%CI=30-35)，女性为22(95%CI=19-24)(n=6；1 472 123 y)，年龄差异很大(例如，HIV阳性的男性男性接触者的IR值为16.8 <； 30 岁至107.5 ≥ 60 )。HIV阴性男男性接触者(n=2，48 135 py)的IR为19(95%CI=10~36)。诊断为外阴癌(IR=48[95%CI=38~61]；n=4；145 147 py)后，肛门癌IR明显高于宫颈癌(9[95%CI=8~12]；n=4；779 098 py)或阴道癌(IR=10[95%CI=3~30]；n=4；32 671)。移植后10 ，SOR组(n=5)IR为13(95%CI=12~15)，男性为24.5，女性为49.6。系统性红斑狼疮、溃疡性结肠炎和克罗恩病的肛门癌IR值分别为10(95%CI=5~19)、6(95%CI=3~11)和3(95%CI=2~4)。总而言之，基于综合荟萃分析的统一的肛门癌风险量表可以改善处于公共卫生初级阶段的肛门癌预防/研究活动的优先顺序和标准化。有什么新鲜事吗？肛门癌(AC)在普通人群中非常罕见。然而，已知一些群体面临更高的风险。在这项荟萃分析中，作者确定了这些群体(例如，HIV阳性状态、其他HPV相关癌症等)，然后能够根据发病率估计制定AC风险量表。由于目前尚无关于AC的标准化筛查的共识，该风险量表可以帮助临床医生优先考虑和比较AC研究和预防措施的风险情况。然后，对于具有类似绝对风险的人群，可以用类似的管理原则来指导这些工作。
Certain population groups are known to have higher than average anal cancer risk, namely persons living with HIV (PLHIV), men who have sex with men (MSM), women diagnosed with human papillomavirus (HPV)‐related gynecological precancerous lesions or cancer, solid organ transplant recipients (SOTRs) and patients with autoimmune diseases. Our aim was to provide robust and comparable estimates of anal cancer burden across these groups. Summary incidence rates (IRs), as cases per 100 000 person‐years (py), were calculated by fixed‐effects meta‐analysis. IRs were 85 (95% confidence interval [CI] = 82‐89) for HIV‐positive MSM (n = 7 studies; 2 229 234 py), 32 (95% CI = 30‐35) for non‐MSM male PLHIV (n = 5; 1626 448 py) and 22 (95% CI = 19‐24) for female PLHIV (n = 6; 1 472 123 py), with strong variation by age (eg, from 16.8 < 30 years to 107.5 ≥ 60 years for HIV‐positive MSM). IR was 19 (95% CI = 10‐36) in HIV‐negative MSM (n = 2; 48 135 py). Anal cancer IRs were much higher after diagnosis of vulvar (IR = 48 [95% CI = 38‐61]; n = 4; 145 147 py) than cervical (9 [95% CI = 8‐12]; n = 4; 779 098 py) or vaginal (IR = 10 [95% CI = 3‐30]; n = 4; 32 671) cancer, with equivalent disparity after respective precancerous lesions. IR was 13 (95% CI = 12‐15) in SOTRs (n = 5; 1 946 206 py), reaching 24.5 and 49.6 for males and females >10 years after transplant. Anal cancer IRs were 10 (95% CI = 5‐19), 6 (95% CI = 3‐11) and 3 (95% CI = 2‐4) for systemic lupus erythematosus, ulcerative colitis and Crohn's disease, respectively. In conclusion, a unifying anal cancer risk scale, based upon comprehensive meta‐analysis, can improve prioritization and standardization in anal cancer prevention/research initiatives, which are in their public health infancy. What's new? Anal cancer (AC) is quite rare in the general population. However, some groups are known to be at higher risk. In this meta‐analysis, the authors identified these groups (e.g., HIV‐positive status, other HPV‐related cancers, etc.), and were then able to develop an AC‐risk scale based on incidence estimates. Because there is currently no consensus regarding standardized screening for AC, this risk scale can help clinicians to prioritize and compare risk profiles for AC research and prevention initiatives. These can then be guided by similar principles of management for populations with similar absolute risk.
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