Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013
Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013
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DOI：
10.1097/lgt.0000000000000395
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发表时间：
2018-07-01
影响因子：
3.7
通讯作者：
Ortiz, Ana P.
中科院分区：
文献类型：
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作者：
Acevedo-Fontanez, Adrianna I.;Suarez, Erick;Ortiz, Ana P.
目的本研究的目的是估计波多黎各（PR）妇女中HPV相关妇科肿瘤和继发性肛门癌之间的关联程度。材料和方法我们确定了1987-2013年期间诊断为原发性宫颈、阴道或外阴肿瘤的9，489名妇女。为了描述浸润性宫颈癌、外阴癌、阴道癌和肛门癌的趋势，使用直接法估计年龄校正的发病率（2000年美国作为标准人群）。标准化发病率使用间接方法计算（观察/预期）;根据PR中肛门癌的年龄特异性发病率，使用2种方法计算预期病例数。使用Poisson回归模型估计肛门癌标准化发病率的比值，以估计HPV-1和HPV-2之间的关联程度。结果1987 - 2013年，肛门癌的发病率呈明显上升趋势（年百分比变化= 1.1，p < .05），而从2004年到2013年，观察到宫颈癌发病率增加（年百分比变化= 3.3，p < .05）。与HPV相关的妇科癌症的女性中继发性肛门癌的风险大约是与非HPV相关的妇科癌症的女性中的风险的3倍（相对风险= 3.27，95%CI = 1.37 ~ 7.79）。结论PR妇女肛门癌发病率增加。与普通人群和非HPV相关妇科癌症患者相比，HPV相关肿瘤患者继发性肛门癌的风险更高。需要为高危人群制定适当的肛门癌筛查指南，包括患有HPV相关妇科恶性肿瘤的妇女和潜在的其他癌症幸存者。
Objective The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR).Materials and Methods We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer.Results A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79).Conclusions Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.