Department of Surgery, Mount Sinai School of Medicine, New York, NY 10011, USA.
J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):259-65. doi: 10.1097/QAI.0b013e3182437469.
Anal squamous cell carcinoma (ASCC) incidence has been rising over the past decade, most dramatically in HIV-positive men who have sex with men (MSM). We aimed to identify a novel in-office approach for ablating high-grade anal intraepithelial neoplasia (HGAIN), the believed precursor lesion to ASCC.
We performed a retrospective analysis of medical records from a New York City surgical practice, identifying patients with HGAIN treated with electrocautery ablation (ECA) and followed for at least 5 months with high-resolution anoscopy, biopsies, and/or cytology. We sought to determine HGAIN recurrence and progression to ASCC after ECA.
Two hundred thirty-two MSM, 132 HIV positive and 100 HIV negative, with median follow-up of 19.0 and 17.5 months, respectively, met inclusion criterion. In HIV-negative and HIV-positive MSM, the probability of curing a lesion after first ECA was 85% and 75%, respectively. Over follow-up, 53% of HIV-negative and 61% of HIV-positive patients recurred. After first and second ECA, HIV-positive MSM were 1.28 times (P = 0.16) and 2.34 times (P = 0.009) more likely to recur than HIV-negative MSM. The majority of recurrence was due to development of additional lesions at untreated sites (metachronous recurrence). One patient (0.4%) developed ASCC. At last visit, 83% of HIV-negative and 69% of HIV-positive patients were HGAIN free.
ECA is an effective treatment for HGAIN, with fewer patients progressing to ASCC than predicted with expectant management. HIV-positive patients are significantly more likely to recur than HIV-negative patients.
在过去的十年中，肛门鳞状细胞癌（ASCC）的发病率一直在上升，尤其是在与男性发生性关系的 HIV 阳性男性（MSM）中。我们旨在确定一种新的门诊方法来消融高级别肛门上皮内瘤变（HGAIN），这是 ASCC 的前病变。
我们对一家纽约市外科诊所的病历进行了回顾性分析，确定了接受电灼消融（ECA）治疗的 HGAIN 患者，并通过高分辨率肛门镜检查、活检和/或细胞学进行了至少 5 个月的随访。我们试图确定 ECA 后 HGAIN 复发和进展为 ASCC。
共有 232 名 MSM，132 名 HIV 阳性，100 名 HIV 阴性，中位随访时间分别为 19.0 和 17.5 个月。在 HIV 阴性和 HIV 阳性 MSM 中，第一次 ECA 后治愈病变的概率分别为 85%和 75%。在随访期间，53%的 HIV 阴性和 61%的 HIV 阳性患者复发。第一次和第二次 ECA 后，HIV 阳性 MSM 复发的可能性分别是 HIV 阴性 MSM 的 1.28 倍（P=0.16）和 2.34 倍（P=0.009）。大多数复发是由于未治疗部位出现新病变（异时性复发）。一名患者（0.4%）发生了 ASCC。最后一次就诊时，83%的 HIV 阴性和 69%的 HIV 阳性患者无 HGAIN。
ECA 是治疗 HGAIN 的有效方法，与期待治疗相比，进展为 ASCC 的患者较少。HIV 阳性患者比 HIV 阴性患者更有可能复发。
