High- resolution anoscopy screening of HIV- positive MSM: longitudinal results from a pilot study
High- resolution anoscopy screening of HIV- positive MSM: longitudinal results from a pilot study
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DOI：
10.1097/qad.0000000000000160
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发表时间：
2014-03-27
期刊：
影响因子：
3.8
通讯作者：
Bower, Mark
中科院分区：
文献类型：
--
作者：
Dalla Pria, Alessia;Alfa-Wali, Maryam;Bower, Mark
背景：发现和治疗癌前病变的能力表明筛查可以预防肛门癌。男男性接触者(MSM)HIV携带者的肛门癌发病率高于筛查前的宫颈癌。方法：对无症状的HIV阳性男男性接触者进行高分辨率肛门镜(HRA)和高度鳞状上皮内病变(HSILs)干预。HSILs患者在6个月后接受治疗并进行HRA随访，而低度鳞状上皮内病变的患者在12个月后再次HRA。结果：368例无症状MSM患者在平均4.2年(最长13年)的中位随访期内总共有1497个HRA。起初，36%的HRA表现正常，16%无不典型增生，15%为肛门上皮内瘤变(AIN-1)，19%为AIN-2，13%为AIN-3。在随访期间，5名患者(1.4%)发展为浸润性肛门癌(发病率为2.7/1000人年)。368名患者的5年癌症发生率为0.3%[95%可信区间0-0.6%]。进展为癌症与较高的年龄(P=0.049)和AIN-3(P=0.024)有关。90名患者的AIN-3至少存在一种HRA。5年时，首次诊断为AIN-3的累积癌症风险为3.2%(95%可信区间0~7.8%)。171例HSIL(AIN-2或AIN-3)至少出现一次。首次诊断为HSIL的5年累积患癌风险为0.6%(95%可信区间为0~1.8%)。结论：AIN-3是肛门癌的重要危险因素，尽管筛查患者检出的肿瘤较小，且总体预后良好。
Background:The ability to detect and treat pre-malignant anal lesions suggests screening may prevent anal cancer. The incidence of anal cancer in men who have sex with men (MSM) living with HIV exceeds that of cervical cancer before screening was introduced.Methods:High-resolution anoscopy (HRA) with intervention for high-grade squamous intraepithelial lesions (HSILs) was offered to asymptomatic HIV-positive MSM. Patients with HSILs were treated and follow-up HRA performed after 6 months, whilst patients with low-grade squamous intraepithelial lesions had a repeat HRA after 12 months.Results:Three hundred and sixty-eight asymptomatic MSM had a total of 1497 HRAs during a median follow-up of 4.2 years (maximum 13 years). At first HRA, 36% had normal appearances, 16% had no dysplasia, 15% anal intraepithelial neoplasia (AIN)-1, 19% AIN-2 and 13% AIN-3. During follow-up, five patients (1.4%) developed invasive anal cancer (incidence 2.7 per 1000 person-years). The 5-year cancer rate for the 368 patients was 0.3% [95% confidence interval (CI) 0-0.6%]. Progression to cancer was associated with higher age (P=0.049) and AIN-3 (P=0.024). Ninety patients had AIN-3 present at least at one HRA. The cumulative risk of cancer from first AIN-3 diagnosis was 3.2% (95% CI 0-7.8%) at 5 years. One hundred and seventy-one patients had HSILs (AIN-2 or 3) present at least once. The cumulative risk of cancer from first HSIL diagnosis was 0.6% (95% CI 0-1.8%) at 5 years.Conclusion:AIN-3 is a significant risk factor for subsequent anal cancer, although the tumours detected in screened patients were small localized, and generally the outcomes were favourable.