Mathilde Gautier1, Charlène Brochard2, Annie Lion1, Sébastien Henno3, Anne Laure Mallet1, Anaïs Bodere1, Guillaume Bouguen2, Astrid Lièvre1, Laurent Siproudhis4. 1. Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France. 2. Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France; CIC-1414 University Hospital of Rennes, Pontchaillou, France. 3. CIC-1414 University Hospital of Rennes, Pontchaillou, France; Department of Pathology, University Hospital of Rennes, Pontchaillou, France. 4. Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France; CIC-1414 University Hospital of Rennes, Pontchaillou, France. Electronic address: laurent.siproudhis@chu-rennes.fr.
Abstract
BACKGROUND: The incidences of high-grade anal intraepithelial neoplasia (HSIL) and superficially invasive squamous cell carcinomas (SISCCA) related to human papillomavirus (HPV) have increased. These lesions can progress to invasive anal cancer. The aim of the study was to assess the clinical outcome with a special focus on the healing rate. METHODS: Forty-six consecutive patients (M/F: 35/11; HIV+: 30) with histologically proven HSIL lesions (N=41) or SISCCA (N=5) were enrolled in a follow-up survey. RESULTS: Of the 46 patients, 40 were treated by excision (n=9), electrocoagulation (n=13), topical treatment (n=2) or combined strategies (n=16). After a mean follow-up of 35 (27-43) months, only one patient progressed to an invasive cancer. Regression and healing were observed in 14 (30%) and 15 (33%) patients. The cumulative probabilities of healing were 14%, 49% and 74% after 1, 3 and 5 years. None of the current smokers healed. Heterosexual patients, sexual abstinence, patients older than 44 years old, non-smokers, patients without any past history of condyloma and those with less than 2 high-risk HPVs at baseline were more likely to heal. CONCLUSION: Progression to invasive cancer is a rare event. Large, prospective cohort studies are needed to plan coherent strategies for both follow-up and treatment.
BACKGROUND: The incidences of high-grade anal intraepithelial neoplasia (HSIL) and superficially invasive squamous cell carcinomas (SISCCA) related to human papillomavirus (HPV) have increased. These lesions can progress to invasive anal cancer. The aim of the study was to assess the clinical outcome with a special focus on the healing rate. METHODS: Forty-six consecutive patients (M/F: 35/11; HIV+: 30) with histologically proven HSIL lesions (N=41) or SISCCA (N=5) were enrolled in a follow-up survey. RESULTS: Of the 46 patients, 40 were treated by excision (n=9), electrocoagulation (n=13), topical treatment (n=2) or combined strategies (n=16). After a mean follow-up of 35 (27-43) months, only one patient progressed to an invasive cancer. Regression and healing were observed in 14 (30%) and 15 (33%) patients. The cumulative probabilities of healing were 14%, 49% and 74% after 1, 3 and 5 years. None of the current smokers healed. Heterosexual patients, sexual abstinence, patients older than 44 years old, non-smokers, patients without any past history of condyloma and those with less than 2 high-risk HPVs at baseline were more likely to heal. CONCLUSION: Progression to invasive cancer is a rare event. Large, prospective cohort studies are needed to plan coherent strategies for both follow-up and treatment.