TY - JOUR
T1 - Risk of Invasive Anal Cancer in HIV-Infected Patients with High-Grade Anal Dysplasia
T2 - A Population-Based Cohort Study
AU - Arens, Yotam
AU - Gaisa, Michael
AU - Goldstone, Stephen E.
AU - Liu, Yuxin
AU - Wisnivesky, Juan
AU - Sigel, Carlie S.
AU - Swartz, Talia H.
AU - Sigel, Keith
N1 - Funding Information:
Funding/Support: This study was supported by the National Cancer Institute (K07CA180782 to Dr Sigel) and the National Institute of Allergy and Infectious Diseases (K08AI120806 to Dr Swartz).
Funding Information:
Financial Disclosures: Dr Goldstone reports grants and personal fees from Merck and Co, grants personal fees and nonfinancial support from Medtronic Inc., outside of the scope of the submitted work. The remaining authors report no conflicts of interest.
Publisher Copyright:
© The American Society of Colon & Rectal Surgeons, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - BACKGROUND: The progression rate and predictors of anal dysplastic lesions to squamous cell carcinoma of the anus remain unclear. Characterizing these parameters may help refine anal cancer screening guidelines. OBJECTIVE: This study aimed to determine the rate of progression of high-grade anal dysplasia to invasive carcinoma in HIV-infected persons. DESIGN: Using the Surveillance, Epidemiology, and End Results database linked to Medicare claims from 2000 to 2011, we identified HIV-infected subjects with incident anal intraepithelial neoplasia III. To estimate the rate of progression of anal intraepithelial neoplasia III to invasive cancer, we calculated the cumulative incidence of anal cancer in this cohort. We then fitted Poisson models to evaluate the potential risk factors for incident anal cancer. SETTINGS: This is a population-based study. PATIENTS: Included were 592 HIV-infected subjects with incident anal intraepithelial neoplasia III. MAIN OUTCOME MEASURES: The primary outcome measured was incident squamous cell carcinoma of the anus. RESULTS: Study subjects were largely male (95%) with a median age of 45.7 years. Within the median follow-up period of 69 months, 33 subjects progressed to anal cancer. The incidence of anal cancer was 1.2% (95% CI, 0.7%-2.5%) and 5.7% (95% CI, 4.0%-8.1%) at 1 and 5 years, following a diagnosis of anal intraepithelial neoplasia III. Risk of progression did not differ by anal intraepithelial neoplasia III treatment status. On unadjusted analysis, black race (p = 0.02) and a history of anogenital condylomata (p = 0.03) were associated with an increased risk of anal cancer incidence, whereas prior anal cytology screening was associated with a decreased risk (p = 0.04). LIMITATIONS: The identification of some incident cancer episodes used surrogate measures. CONCLUSIONS: In our population-based cohort of HIV-infected subjects with long-term follow-up, the risk of progression from anal intraepithelial neoplasia III to anal squamous cell carcinoma was higher than reported in other studies and was not associated with the receipt of anal intraepithelial neoplasia III treatment. See Video Abstract at http://links.lww.com/DCR/A933.
AB - BACKGROUND: The progression rate and predictors of anal dysplastic lesions to squamous cell carcinoma of the anus remain unclear. Characterizing these parameters may help refine anal cancer screening guidelines. OBJECTIVE: This study aimed to determine the rate of progression of high-grade anal dysplasia to invasive carcinoma in HIV-infected persons. DESIGN: Using the Surveillance, Epidemiology, and End Results database linked to Medicare claims from 2000 to 2011, we identified HIV-infected subjects with incident anal intraepithelial neoplasia III. To estimate the rate of progression of anal intraepithelial neoplasia III to invasive cancer, we calculated the cumulative incidence of anal cancer in this cohort. We then fitted Poisson models to evaluate the potential risk factors for incident anal cancer. SETTINGS: This is a population-based study. PATIENTS: Included were 592 HIV-infected subjects with incident anal intraepithelial neoplasia III. MAIN OUTCOME MEASURES: The primary outcome measured was incident squamous cell carcinoma of the anus. RESULTS: Study subjects were largely male (95%) with a median age of 45.7 years. Within the median follow-up period of 69 months, 33 subjects progressed to anal cancer. The incidence of anal cancer was 1.2% (95% CI, 0.7%-2.5%) and 5.7% (95% CI, 4.0%-8.1%) at 1 and 5 years, following a diagnosis of anal intraepithelial neoplasia III. Risk of progression did not differ by anal intraepithelial neoplasia III treatment status. On unadjusted analysis, black race (p = 0.02) and a history of anogenital condylomata (p = 0.03) were associated with an increased risk of anal cancer incidence, whereas prior anal cytology screening was associated with a decreased risk (p = 0.04). LIMITATIONS: The identification of some incident cancer episodes used surrogate measures. CONCLUSIONS: In our population-based cohort of HIV-infected subjects with long-term follow-up, the risk of progression from anal intraepithelial neoplasia III to anal squamous cell carcinoma was higher than reported in other studies and was not associated with the receipt of anal intraepithelial neoplasia III treatment. See Video Abstract at http://links.lww.com/DCR/A933.
KW - Anal cancer
KW - Anal dysplasia
KW - Anal intraepithelial neoplasia
KW - Epidemiology, and End Results
KW - Human papillomavirus
KW - Incidence
KW - Progression
KW - Squamous cell carcinoma of the anus
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=85066100891&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000001384
DO - 10.1097/DCR.0000000000001384
M3 - Article
C2 - 30888979
AN - SCOPUS:85066100891
SN - 0012-3706
VL - 62
SP - 934
EP - 940
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 8
ER -