High-grade intraepithelial lesions of the anus-patience: A road to wisdom.

AIM

The progression of high-grade squamous intraepithelial lesions (HSILs) to anal cancer is feared. Data on the remission of HSILs are scarce, and factors associated with remission have not been identified. The aims of this study were to determine the rate of remission of HSILs and to identify factors associated with remission.

METHOD

Consecutive patients with HSILs referred to a tertiary proctology unit for monitoring were identified in a prospective database. Clinical data, as well as cytological, histological and treatment data, were recorded. The remission of HSILs was defined by the normality of the macroscopic examination and the normal histology and/or cytology of at least two consecutive samples.

RESULTS

Overall, 144 patients with HSILs were followed for 4.1 (2.1-6.5) years. The cumulative probabilities of remission of HSILs were 9.7% (6.2%-14.9%), 14.6% (10.1%-20.7%) and 23.8% (17.3%-31.8%) at 2, 3 and 5 years, respectively. Human papillomavirus 16 (HPV16) clearance was achieved in 19/84 (22.6%) patients. Multivariate analysis revealed that three main factors were associated with remission of HSILs: absence of HPV16 at referral [hazard ratio (HR) 0.3, 95% CI 0.1-0.9], location (absence of endoanal lesion) of HSILs (HR 0.1, 95% CI 0.01-0.08) and excision of HSILs (HR 3.2, 95% CI 1.1-9.0).

CONCLUSION

The remission of HSILs was not a frequent event in this long-term cohort study. HPV16 is a pejorative factor, while other high-risk HPVs are not. Excision of the HSIL, when possible, could be a preferred treatment to allow better remission.