人类免疫缺陷病毒（HIV）感染背景下的尖锐湿疣、肛管上皮内瘤变及肛管癌：我们真的了解其风险吗？

Condyloma Acuminatum, Anal Intraepithelial Neoplasia, and Anal Cancer in the Setting of HIV: Do We Really Understand the Risk?

作者信息

Fazendin Edward A, Crean Alexander J, Fazendin Jessica M, Kucejko Robert J, Gill Harkenwar S, Poggio Juan L, Stein David E

机构信息

1 Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania 2 Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania 3 Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania.

出版信息

Dis Colon Rectum. 2017 Oct;60(10):1078-1082. doi: 10.1097/DCR.0000000000000890.

DOI:10.1097/DCR.0000000000000890

PMID:28891852

Abstract

BACKGROUND

The gold standard for surveillance of patients with anal lesions is unclear.

OBJECTIVE

The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease.

DESIGN

This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis.

SETTINGS

The study was conducted at an urban university hospital.

PATIENTS

HIV-positive patients with anal lesions treated with excision and fulguration were included.

MAIN OUTCOME MEASURES

Recurrence of anal lesions, progression of disease, and progression to cancer were measured.

RESULTS

Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0-106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort).

LIMITATIONS

This was a single institution study. High-resolution anoscopy was not used.

CONCLUSIONS

All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.

摘要

背景

肛门病变患者监测的金标准尚不清楚。

目的

本研究旨在对疾病进展风险的患者进行分层，并确定肛门疾病患者监测的合适间隔时间。

设计

这是一项对2007年至2014年间接受肛门病变治疗患者的回顾性病历审查。仅纳入自索引评估、病理、记录的体格检查和肛门镜检查结果起有≥1年随访的患者进行分析。

地点

该研究在一家城市大学医院进行。

患者

纳入接受切除和电灼治疗的HIV阳性肛门病变患者。

主要观察指标

测量肛门病变的复发、疾病进展和进展为癌症的情况。

结果

91名患者符合纳入标准。平均年龄为41.6岁，平均随访时间为38.6个月（范围11.0 - 106.0个月）。初始病理检查时，8名患者（8.8%）诊断为无发育异常的尖锐湿疣，20名患者（22%）患有肛门上皮内瘤变I级，32名（35.2%）患有肛门上皮内瘤变II级，31名（34.1%）患有肛门上皮内瘤变III级。69名患者（75.8%）接受了重复手术。8名尖锐湿疣患者中的7名（87.5%）和20名肛门上皮内瘤变I级患者中的6名（30%）进展为高级别病变。32名肛门上皮内瘤变II级患者中的5名（15.6%）进展为III级，2名肛门上皮内瘤变III级患者（6.5%）发生鳞状细胞癌（整个队列的2.3%）。