Junejo Muhammad Hyder, Oyebanji Oluwatobiloba Ifeoluwa, Wang Baihan, Cappello Carmelina, Wait Brenton, Farrow Emily, Nathan Mayura, Bowring Julie, Cuming Tamzin
Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
Homerton Anogenital Neoplasia Service, Hackney, London, UK.
Clin Exp Dermatol. 2025 Jan 27;50(2):395-398. doi: 10.1093/ced/llae362.
In the UK, few (12%) anal squamous cell carcinomas (aSCCs) are diagnosed early at stage 1 (T1N0M0). The Homerton Anogenital Neoplasia Service (HANS) is a highly specialized tertiary centre where high-resolution anoscopy (HRA) is performed to diagnose and treat anal intraepithelial neoplasia (AIN), a precursor to cancer. In some cases, aSCC (here defined as anal canal cancers and perianal cancers up to 5 cm from the anal verge) is found on referral for AIN; in others, aSCC may develop during management of AIN. We reviewed aSCC diagnoses at our specialist unit to establish whether HRA offers added value in the early detection of aSCC in a high-risk cohort. A cross-sectional analysis was performed of all primary aSCC diagnoses at HANS between January 2016 and June 2021. Patient records and histopathology and radiology reports were reviewed to define anal cancer stage per TNM classification (AJCC version 8). The results were compared with national anal cancer data published by the Office for National Statistics (AJCC version 8). Fifty-three aSCC diagnoses were made at HANS; 35 (66%) were stage 1 (14 prevalent, 21 incident), 11 (21%) stage 2 (9 prevalent, 2 incident) and 6 (11%) stage 3 (5 prevalent, 1 incident). None were stage 4, and one cancer was unstageable due to further management at another unit. By comparison, 5836 aSCCs were diagnosed in the UK between 2013 and 2017. Of these, 12.0% were stage 1, 22.8% stage 2, 33.0% stage 3 and 8.5% stage 4; 23.8% were unknown or unstageable. There was a statistically significant difference in the proportion of early (i.e. stage 1) HRA-detected cancers between HANS and national statistics (P < 0.001). Our results suggest that surveillance and examination within an HRA programme may lead to the detection of aSCC at an earlier stage, allowing for less morbid treatment and potentially lower mortality.
在英国，很少有肛管鳞状细胞癌（aSCC）能在1期（T1N0M0）被早期诊断出来（12%）。霍默顿肛门生殖器肿瘤服务中心（HANS）是一家高度专业化的三级中心，在该中心会进行高分辨率肛门镜检查（HRA）以诊断和治疗肛门上皮内瘤变（AIN），这是癌症的前体病变。在某些情况下，转诊来诊断AIN时会发现aSCC（这里定义为肛管癌和距肛缘5厘米以内的肛周癌）；在其他情况下，aSCC可能在AIN的治疗过程中发生。我们回顾了我们专科单位的aSCC诊断情况，以确定HRA在高危人群中早期检测aSCC方面是否具有附加价值。对2016年1月至2021年6月期间HANS所有原发性aSCC诊断进行了横断面分析。查阅了患者记录以及组织病理学和放射学报告，以根据TNM分类（美国癌症联合委员会第8版）确定肛管癌分期。将结果与国家统计局公布的国家肛管癌数据（美国癌症联合委员会第8版）进行了比较。HANS共做出了53例aSCC诊断；35例（66%）为1期（14例为现患，21例为新发病例），11例（21%）为2期（9例为现患，2例为新发病例），6例（11%）为3期（5例为现患，1例为新发病例）。无4期病例，有1例癌症因在另一个单位进一步治疗而无法分期。相比之下，2013年至2017年期间英国共诊断出5836例aSCC。其中，12.0%为1期，22.8%为2期，33.0%为3期，8.5%为4期；23.8%为未知或无法分期。HANS与国家统计数据中早期（即1期）通过HRA检测出的癌症比例存在统计学显著差异（P<0.001）。我们的结果表明，HRA项目中的监测和检查可能会在更早阶段检测出aSCC，从而实现创伤性较小的治疗并可能降低死亡率。
