Cranston Ross D, Baker Jonathan R, Liu Yimeng, Wang Lu, Elishaev Esther, Ho Ken S
From the *Department of Medicine, University of Pittsburgh, Pittsburgh, PA; †University of Pittsburgh Medical Center, Pittsburgh, PA; ‡Statistics Consulting Laboratory, Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA; and §Department of Pathology at Magee-Womens Hospital, Pittsburgh, PA.
Sex Transm Dis. 2014 Jul;41(7):420-6. doi: 10.1097/OLQ.0000000000000145.
To assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals.
All patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013.
A total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed.
Topical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the following: low cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.
评估外用80%三氯乙酸（TCA）治疗HIV阳性个体肛管高级别鳞状上皮内病变（HSILs）的疗效。
纳入2009年7月1日至2012年6月30日期间在匹兹堡大学肛管发育异常诊所就诊、经活检证实为肛管HSIL并接受外用TCA治疗且进行了1次或多次随访以评估治疗效果的所有患者。于2013年7月1日评估HSIL的复发情况。
共治疗了来自72例患者的98处HSIL，77处（78.6%）在随访期间恢复为正常上皮或低级别SIL。分别有48处（49.0%）和27处（27.6%）病变经1次和2次TCA治疗后恢复，而分别有1处（1%）病变经3次和4次TCA治疗后恢复。20例患者中的21处（21.4%）病变在TCA治疗后仍未恢复。这些患者接受了替代治疗。随访期间，53例患者中有8例（15.1%）在原部位出现病变复发（11/53 [20.8%]，包括相邻病变），17例患者诊断出有新病变。
在具备高分辨率肛门镜检查能力的肛管发育异常诊所环境中，外用TCA是治疗肛管HSIL的有效方法。TCA用于这种复发性疾病过程的优势包括：成本低、除高分辨率肛门镜检查所需设备外无需特殊设备，且应用过程无痛。一项更大规模的前瞻性比较研究将能更好地明确不同治疗方法之间的疗效和患者可接受性。
