Albuquerque A, Pessegueiro Miranda H, Lopes J, Gandara J, Rodrigues S, Gaspar R, Morais R, Ramalho R, Rodrigues-Pinto E, Cardoso H, Barroca H, Dias C C, Carneiro F, Macedo G
Gastroenterology Department Centro Hospitalar São João, Porto, Portugal.
Faculty of Medicine of the University of Porto, Porto, Portugal.
Br J Cancer. 2017 Dec 5;117(12):1761-1767. doi: 10.1038/bjc.2017.370. Epub 2017 Oct 31.
Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting.
Prospective case-control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results.
Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22-28.12, P=0.027).
Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.
肛管鳞状上皮内病变（ASIL）是肛管鳞状细胞癌的癌前病变，在免疫抑制患者中患病率较高。已有一些关于肾移植受者的研究，但尚无关于肝移植受者患病率的信息。我们的目的是评估这种情况下ASIL的患病率。
对无其他已知ASIL危险因素的肝移植受者进行前瞻性病例对照研究（n = 59），并与健康对照组（n = 57）进行比较。所有患者均接受肛管细胞学检查，结果异常者进行高分辨率肛门镜检查。
10名（17%）肝移植受者细胞学检查结果异常，7例为意义不明确的非典型鳞状细胞（ASC-US），1例为不能排除高级别病变的非典型鳞状细胞（ASC-H），2例为高级别鳞状上皮内病变（HSIL）。对照组中有1例（2%）为ASC-US结果（P = 0.005）。通过高分辨率肛门镜检查及活检，10例肝移植患者中有7例确诊为肛管鳞状上皮内病变，而对照组1例中无确诊病例（P = 0.013）。当前吸烟是细胞学异常的唯一危险因素（比值比=5.87，95%置信区间=1.22 - 28.12，P = 0.027）。
肝移植患者发生ASIL的风险较高。应考虑进行筛查，尤其是对吸烟者。
