Severe anal intraepithelial neoplasia trends and subsequent invasive anal cancer in the United States.
Severe anal intraepithelial neoplasia trends and subsequent invasive anal cancer in the United States.
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美国严重肛门上皮内瘤变趋势和随后的侵袭性肛门癌。
DOI：
10.1093/jnci/djad176
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Shiels,MeredithS
中科院分区：
文献类型：
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作者：
Haas,CameronB;Engels,EricA;Palefsky,JoelM;Clarke,MeganA;Kreimer,AiméeR;Luo,Qianlai;Pfeiffer,RuthM;Qiao,Baozhen;Pawlish,KarenS;Monterosso,Analise;Shiels,MeredithS
背景：肛门上皮内瘤变III级是肛门鳞状细胞癌的前兆，在美国，HIV感染者的发病率是普通人群的近20倍。我们描述了肛门上皮内瘤变III级诊断的趋势和肛门鳞状细胞癌的风险后肛门上皮内瘤变III级艾滋病毒状态和sex.MethodsWe使用的数据从基于人口的癌症和艾滋病毒登记处之间的联系在美国11个州;波多黎各;和华盛顿，DC，在1996-2019年。我们确定了所有诊断为肛门上皮内瘤变III级的个体，并确定了他们的HIV状态。我们采用Poisson回归法按HIV状态和性别分层，估计了肛门上皮内瘤变III级的平均年百分比变化。我们估计了肛门鳞状细胞癌的5年累积发病率后，肛门上皮内瘤变III级诊断分层的性别，艾滋病毒感染状况，和先前的艾滋病诊断。肛门上皮内瘤变III级的年平均百分比变化为15%（95%置信区间[CI] = 12%至17%），男性为12%（95% CI = 11%至14%）。未感染艾滋病毒者的平均年百分比变化为女性8%（95% CI = 7%至8%），男性8%（95% CI = 6%至9%）。在艾滋病毒感染者中，既往诊断出艾滋病与女性和男性的肛门上皮内瘤变III级诊断风险分别增加2.7倍（95%CI = 2.23至3.40）和1.9倍（95%CI = 1.72至2.02）。五年累计发病率的肛门鳞状细胞癌的肛门上皮内瘤变III级的人与艾滋病诊断前分别为3.4%和3.7%for female and male，respectively.ConclusionsRates肛门上皮内瘤变III级的诊断自1996年以来有所增加，特别是对艾滋病病毒感染者，可能受到增加筛选。既往艾滋病诊断与肛门上皮内瘤变III级诊断风险密切相关。
BackgroundAnal intraepithelial neoplasia grade III is a precursor to squamous cell carcinoma of the anus for which rates are nearly 20-fold higher in people with HIV than in the general population in the United States. We describe trends in anal intraepithelial neoplasia grade III diagnosis and risk of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III by HIV status and sex.MethodsWe used data from a population-based linkage between cancer and HIV registries in 11 US states; Puerto Rico; and Washington, DC, during 1996-2019. We identified all individuals with a diagnosis of anal intraepithelial neoplasia grade III and determined their HIV status. We estimated the average annual percentage change of anal intraepithelial neoplasia grade III using Poisson regression stratified by HIV status and sex. We estimated the 5-year cumulative incidence of squamous cell carcinoma of the anus following an anal intraepithelial neoplasia grade III diagnosis stratified by sex, HIV status, and prior AIDS diagnosis.ResultsAmong people with HIV, average annual percentage changes for anal intraepithelial neoplasia grade III were 15% (95% confidence interval [CI] = 12% to 17%) per year among females and 12% (95% CI = 11% to 14%) among males. Average annual percentage changes for those without HIV were 8% (95% CI = 7% to 8%) for females and 8% (95% CI = 6% to 9%) for males. Among people with HIV, a prior AIDS diagnosis was associated with a 2.7-fold (95% CI = 2.23 to 3.40) and 1.9-fold (95% CI = 1.72 to 2.02) increased risk of anal intraepithelial neoplasia grade III diagnosis for females and males, respectively. Five-year cumulative incidence of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III for people with HIV with a prior AIDS diagnosis were 3.4% and 3.7% for females and males, respectively.ConclusionsRates of anal intraepithelial neoplasia grade III diagnoses have increased since 1996, particularly for people with HIV, likely influenced by increased screening. A prior AIDS diagnosis was strongly associated with risk of anal intraepithelial neoplasia grade III diagnosis.