Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark.
Int J Cancer. 2022 Oct 15;151(8):1240-1247. doi: 10.1002/ijc.34143. Epub 2022 Jun 15.
Little is known about risk factors for progression of high-grade anal intraepithelial neoplasia (AIN) to anal squamous cell carcinoma (ASCC). In this large, population-based study, we assess the role of factors related to immune status for the risk of ASCC among individuals from the general population with a diagnosis of AIN3. Individuals diagnosed with AIN3 during 1985-2016 were identified in the Danish Pathology Registry and followed for subsequent development of ASCC. The study population was linked to the National Patient Registry, the Danish Prescription Registry and the Danish HIV Cohort Study for information on autoimmune disease, genital warts and HIV status. To study the progression rate, Cox regression models with hazard ratios (HR) and 95% confidence intervals (CI) were applied with time since AIN3 as the underlying time scale and with adjustment for age at AIN3 diagnosis, year of AIN3 diagnosis and sex. The study population comprised 1222 individuals with AIN3 contributing 12 824 person-years of follow-up. Ninety-seven individuals (7.9%) developed ASCC. Individuals registered with an autoimmune disease or genital warts before and/or after the AIN3 diagnosis had an increased rate of progression to ASCC compared to individuals without these conditions. People living with HIV had a higher progression rate than HIV-negative individuals (HR = 4.25; 95% CI: 1.87-9.65) with the highest progression rate among those with CD4 count ≤200 cells/μL. These associations may be caused by an interplay between HPV infection and immunosuppression.
人们对于高级别肛门上皮内瘤变（AIN）进展为肛门鳞状细胞癌（ASCC）的风险因素知之甚少。在这项大规模的基于人群的研究中，我们评估了与免疫状态相关的因素在一般人群中 AIN3 患者发生 ASCC 风险中的作用。在 1985 年至 2016 年期间，丹麦病理学登记处确定了诊断为 AIN3 的个体，并对其进行了后续随访，以了解是否发生了 ASCC。研究人群与国家患者登记处、丹麦处方登记处和丹麦 HIV 队列研究相关联，以获取自身免疫性疾病、生殖器疣和 HIV 状态的信息。为了研究进展率，应用 Cox 回归模型，使用 AIN3 后时间作为基础时间尺度，并调整 AIN3 诊断时的年龄、AIN3 诊断年份和性别，计算了风险比（HR）和 95%置信区间（CI）。研究人群包括 1222 名 AIN3 患者，共随访 12824 人年。97 名患者（7.9%）发生了 ASCC。与没有这些疾病的患者相比，在 AIN3 诊断之前和/或之后登记自身免疫性疾病或生殖器疣的患者发生 ASCC 的进展率更高。与 HIV 阴性个体相比，HIV 阳性个体的进展率更高（HR=4.25；95%CI：1.87-9.65），CD4 计数≤200 个/μL 的患者进展率最高。这些关联可能是 HPV 感染和免疫抑制之间相互作用的结果。
