Department of Dermatology, Ruhr University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.
Br J Dermatol. 2010 Jun;162(6):1269-77. doi: 10.1111/j.1365-2133.2010.09712.x. Epub 2010 Feb 22.
Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-associated potential precursor lesion of anal cancer, is frequent among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). There is a paucity of data published on the progression of high-grade AIN to invasive cancer as well as on clinical and virological characteristics comparing anal margin and anal canal carcinoma.
To search for anal carcinoma and AIN in a large series of HIV-positive MSM, to assess treatment response of anal carcinoma, and to analyse lesional HPV spectrum of anal cancers.
Detection of anal carcinoma and AIN was performed using cytology, high-resolution anoscopy, and histology in case of abnormal findings. Additionally, HPV analyses for 36 high- and low-risk α-HPV types were performed in patients with anal carcinoma.
In total, 446 German HIV-positive MSM were examined within an observation period of 5 years and 10 months. Of these, 116 (26·0%) patients had normal findings, 163 (36·5%) had low-grade AIN, 156 (35·0%) had high-grade AIN, and 11 (2·5%) had anal carcinoma as evidenced by the highest grade of cytology/histology. Five patients with anal cancer, who had refused treatment of their precancerous lesions, had progressed from high-grade AIN to invasive cancer within a median time of 8·6 months. All anal cancers carried high-risk α-HPV types. All five squamous cell carcinomas (SCCs) of the anal canal were HPV16 positive. In contrast, only one of the four anal margin SCCs were HPV16 positive (HPV31, HPV33 and HPV33 + HPV68 were found in the other three anal margin SCCs). HPV59 was found in two adenocarcinomas, one of which additionally carried HPV33. In contrast to the cancer biopsies, a broad spectrum of surface high- and low-risk HPV types was found in anal swabs of the patients. Surgical excision resulted in long-term disease control of all anal margin carcinomas, whereas combined chemoradiotherapy in carcinomas of the anal canal was associated with high recurrence rates, high toxicity, and high mortality.
Anal carcinoma and AIN are frequent in HIV-positive men, even in patients participating in anal cancer prevention programmes. High-grade dysplasia in these patients can progress to invasive cancer within a short period of time. Anal margin carcinoma and anal canal carcinoma differ substantially in their lesional HPV spectrum, prognosis and treatment response.
肛门上皮内瘤变（AIN）是一种与人类乳头瘤病毒（HPV）相关的潜在肛门癌前病变，在人类免疫缺陷病毒（HIV）阳性的男男性行为者（MSM）中较为常见。目前，关于高级别 AIN 进展为浸润性癌的资料以及比较肛门边缘和肛门管癌的临床和病毒学特征的资料都很匮乏。
在大量 HIV 阳性 MSM 中寻找肛门癌和 AIN，评估肛门癌的治疗反应，并分析肛门癌的 HPV 谱。
对出现异常的患者采用细胞学、高分辨率肛门镜和组织学检查来检测肛门癌和 AIN。另外，对患有肛门癌的患者进行了针对 36 种高危和低危 α-HPV 型的 HPV 分析。
在 5 年 10 个月的观察期内，共检查了 446 名德国 HIV 阳性 MSM。其中，116 名（26.0%）患者无异常发现，163 名（36.5%）患者有低级别 AIN，156 名（35.0%）患者有高级别 AIN，11 名（2.5%）患者的细胞学/组织学最高级别证实为肛门癌。5 名患有肛门癌且拒绝治疗其癌前病变的患者，在中位时间 8.6 个月内从高级别 AIN 进展为浸润性癌。所有肛门癌均携带高危 α-HPV 型。4 例肛门管 SCC 中均为 HPV16 阳性。相比之下，在另外 3 例肛门边缘 SCC 中发现 HPV31、HPV33 和 HPV33+HPV68，只有 1 例肛门边缘 SCC 为 HPV16 阳性（HPV31）。在 2 例腺癌中发现 HPV59，其中 1 例还携带 HPV33。与癌症活检相比，患者的肛门拭子中发现了广泛的表面高危和低危 HPV 型。肛门边缘癌的手术切除可长期控制疾病，而肛门管癌的联合放化疗则与高复发率、高毒性和高死亡率相关。
肛门癌和 AIN 在 HIV 阳性男性中很常见，即使是参加肛门癌预防计划的患者也是如此。这些患者的高级别发育不良可在短时间内进展为浸润性癌。肛门边缘癌和肛门管癌在病变 HPV 谱、预后和治疗反应方面有很大差异。
