Gouriou C, Landemaine A, Carlo A, Boisteau E, Henno S, Thibault V, Lievre A, Siproudhis L, Brochard C
Department of Gastroenterology, CHU Rennes, University of Rennes, Rennes, France.
Department of Pathological Anatomy and Cytology, CHU Rennes, University of Rennes, Rennes, France.
Colorectal Dis. 2025 Mar;27(3):e70053. doi: 10.1111/codi.70053.
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.
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.
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).
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.
高级别鳞状上皮内病变（HSILs）进展为肛门癌令人担忧。关于HSILs缓解的数据稀少，且尚未确定与缓解相关的因素。本研究的目的是确定HSILs的缓解率，并识别与缓解相关的因素。
在一个前瞻性数据库中识别出连续转诊至三级直肠病科进行监测的HSILs患者。记录临床数据以及细胞学、组织学和治疗数据。HSILs的缓解定义为宏观检查正常以及至少两个连续样本的组织学和/或细胞学正常。
总体而言，144例HSILs患者随访了4.1（2.1 - 6.5）年。HSILs在2年、3年和5年时的累积缓解概率分别为9.7%（6.2% - 14.9%）、14.6%（10.1% - 20.7%）和23.8%（17.3% - 31.
