Cachay E, Agmas W, Mathews C
Department of Medicine, University of California at San Diego, San Diego, CA, USA.
HIV Med. 2015 Mar;16(3):191-5. doi: 10.1111/hiv.12190. Epub 2014 Sep 6.
The aim of the study was to estimate the cumulative incidence of, and rates of progression to, invasive anal cancer (IAC) according to baseline anal cytology screening category in an unselected HIV clinical care cohort in the antiretroviral era.
A retrospective cohort analysis of HIV-infected patients under care at the University of California at San Diego Owen Clinic was carried out. Patients were eligible for this analysis if they had at least two anal cytohistological results available for longitudinal analysis. Kaplan-Meier analysis was used to estimate the cumulative incidence of IAC over time according to baseline cytology category [less than high-grade intraepithelial lesion (HSIL) versus HSIL]. Cox regression analysis was used to adjust for the following covariates: antiretroviral use, level of HIV viraemia, smoking status and infrared photocoagulation (IRC) ablation therapy.
Between 2000 and 2012, we followed 2804 HIV-infected patients for a median of 4 years under a clinic protocol requiring baseline anal cytology screening. Incident IAC was diagnosed in 23 patients. Patients with a baseline HSIL anal cytology had an estimated 5-year probability of progression to IAC of 1.7% and an estimated annual progression risk of 1 in 263. None of the examined covariates was significantly associated with IAC incidence when examined in separate unadjusted Cox models.
HIV-infected patients with a baseline HSIL anal cytology had a 5-year cumulative incidence of IAC of 1.65%, with an upper 95% confidence bound of 4.5%. This population-based study provides quantitative risk estimates that may be used for counselling patients regarding management options for abnormal cytology results.
本研究旨在根据抗逆转录病毒时代未选择的HIV临床护理队列中的基线肛门细胞学筛查类别,估计浸润性肛门癌(IAC)的累积发病率及进展率。
对加利福尼亚大学圣地亚哥分校欧文诊所接受护理的HIV感染患者进行回顾性队列分析。若患者至少有两次肛门细胞组织学结果可用于纵向分析,则符合本分析条件。采用Kaplan-Meier分析根据基线细胞学类别[低于高级别上皮内病变(HSIL)与HSIL]估计IAC随时间的累积发病率。采用Cox回归分析对以下协变量进行校正:抗逆转录病毒药物使用情况、HIV病毒血症水平、吸烟状况和红外光凝(IRC)消融治疗。
2000年至2012年期间,我们按照要求进行基线肛门细胞学筛查的临床方案,对2804例HIV感染患者进行了中位时间为4年的随访。23例患者被诊断为IAC。基线肛门细胞学为HSIL的患者进展为IAC的估计5年概率为1.7%,估计年进展风险为263分之一。在单独的未校正Cox模型中检查时,所检查的协变量均与IAC发病率无显著关联。
基线肛门细胞学为HSIL的HIV感染患者IAC的5年累积发病率为1.65%,95%置信上限为4.5%。这项基于人群的研究提供了定量风险估计,可用于为患者提供有关异常细胞学结果管理方案的咨询。