Simpson Steve, Turner Richard
University of Tasmania, Hobart, Australia.
Sex Health. 2012 Jul;9(3):213-9. doi: 10.1071/SH11002.
Anal cancer is a rare cancer analogous to cervical cancer, largely caused by exposure to oncogenic human papillomavirus. We have sought to study this disease in the epidemiologically distinct population of Tasmania.
Medical records at all tertiary and secondary referral centres in Tasmania were audited for records with corresponding International Classification of Diseases (ICD)-10 codes. Statistical significances of trends were evaluated using Fisher's exact test, logistic regression or linear regression.
Of ~1350 screening records, 170 cases of anal cancer were found with patient presentation during 1973-2010, corresponding to 132 patients. This cohort was mostly female (66.7%), with squamous cell histology (81.8%) and anal canal primaries (72.0%). Most cases were detected at Stage II or below and the majority remained disease-free after treatment. Relatively few cases had documentation of typical risk factors for anal cancer, such as HIV seropositivity, a history of cancer or smoking. After 2000, there was a trend towards a lower stage at presentation, correlating with an increased 5-year survival. After 2000, no anal margin tumours presented beyond Stage II; nearly half were detected in situ and none were fatal. For anal canal tumours, there was virtually no change in the mean stage at detection or in survival.
This is the first case series of anal cancer in Tasmania. We find that in many ways, including symptoms and pathology at presentation, epidemiology is typical. However, our cohort is distinct in its paucity of known risk groups, including HIV-positive people, those with a history of cancer and smokers.
肛管癌是一种类似于宫颈癌的罕见癌症，主要由接触致癌性人乳头瘤病毒引起。我们试图在塔斯马尼亚岛这个流行病学特征独特的人群中研究这种疾病。
对塔斯马尼亚岛所有三级和二级转诊中心的病历进行审核，查找具有相应国际疾病分类（ICD）-10编码的记录。使用Fisher精确检验、逻辑回归或线性回归评估趋势的统计学显著性。
在约1350份筛查记录中，发现170例肛管癌病例，患者就诊时间为1973年至2010年，对应132名患者。该队列中女性居多（66.7%），组织学类型为鳞状细胞癌（81.8%），原发部位在肛管（72.0%）。大多数病例在II期或以下被检测到，大多数患者治疗后无疾病复发。相对较少的病例记录有肛管癌的典型危险因素，如HIV血清阳性、癌症病史或吸烟史。2000年后，就诊时疾病分期有降低的趋势，与5年生存率提高相关。2000年后，没有超过II期的肛管边缘肿瘤出现；近一半为原位癌，无一例死亡。对于肛管肿瘤，检测时的平均分期或生存率几乎没有变化。
这是塔斯马尼亚岛首个肛管癌病例系列。我们发现，在许多方面，包括就诊时的症状和病理，其流行病学特征具有典型性。然而，我们的队列与众不同之处在于已知风险人群较少，包括HIV阳性者、有癌症病史者和吸烟者。
