Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
Surg Oncol. 2013 Dec;22(4):230-7. doi: 10.1016/j.suronc.2013.08.002. Epub 2013 Aug 26.
The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease.
A systematic review of the literature was undertaken using Medline, Embase, Cochrane and Web of Science.
A total of 33 cases of anal SCC were described, 7 in ulcerative colitis (UC) and 26 in Crohn's disease (CD). The annual incidence of anal SCCs was 0.9/100,000 and 2.0/100,000 in patients with UC and CD respectively. The gender ratio in CD was 3M:17F with a median age of 42 years, the main presenting symptom was anal pain and 85% of CD cases had peri-anal disease. No studies described anal intra-epithelial neoplasia. The human papilloma virus was found to be positive in 2 out of 5 (40%) cases. The majority of patients (73%) with CD received radical surgery as their first line treatment. The cumulative overall and disease free survival in CD was 37 per cent at five years.
The findings of this review when contrasted with the data from cancer registries suggests that there is a higher incidence of anal SCC, an earlier age of presentation and poorer outcomes in patients with Crohn's disease compared to the general population implying a more aggressive neoplastic process. This review supports the hypothesis that peri-anal disease plays a contributing role in anal SCCs and as such targeted surveillance in patients with longstanding peri-anal disease should be considered.
本系统评价的目的是确定患有炎症性肠病的患者中出现的肛门鳞状细胞癌（SCC）的发病率、病因和临床特征。
使用 Medline、Embase、Cochrane 和 Web of Science 进行文献系统评价。
共描述了 33 例肛门 SCC，7 例溃疡性结肠炎（UC）和 26 例克罗恩病（CD）。UC 和 CD 患者肛门 SCC 的年发病率分别为 0.9/100,000 和 2.0/100,000。CD 的性别比例为 3M:17F，中位年龄为 42 岁，主要症状为肛门疼痛，85%的 CD 病例有肛周疾病。没有研究描述肛门上皮内瘤变。发现 5 例中的 2 例（40%）人乳头瘤病毒阳性。大多数（73%）CD 患者接受根治性手术作为一线治疗。CD 的 5 年总生存率和无病生存率为 37%。
与癌症登记数据相比，本研究结果表明，与普通人群相比，克罗恩病患者的肛门 SCC 发病率更高，发病年龄更早，预后更差，这意味着更具侵袭性的肿瘤过程。本综述支持肛周疾病在肛门 SCC 中起作用的假设，因此应考虑对长期肛周疾病患者进行靶向监测。
