罹患肛门癌高风险的感染艾滋病毒女性的肛门癌筛查随访时间
Follow-Up Time of Anal Cancer Screening among Women Living with HIV at High Risk of Developing Anal Cancer.
作者信息
Masiano Steven P, Green Tiffany L, Dahman Bassam, Kimmel April D
机构信息
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Oncol Res Treat. 2025 May 31:1-11. doi: 10.1159/000546717.
INTRODUCTION
Screening for anal cancer can help in its secondary prevention. We examined follow-up time for anal cancer screening among high-risk women living with HIV (WLHIV) and whether it varies with the number of risk factors for developing anal cancer.
METHODS
A retrospective cohort study involving high-risk WLHIV under 65 enrolled in Medicaid for at least 2 years across 16 US states plus D.C. from 2009 to 2012. High risk was defined by a history of abnormal cervical test results or genital warts. Initial anal cancer screening was the first screening after a high-risk diagnosis, with results classified as normal or abnormal. Follow-up was until the next screening. Follow-up time was analyzed using the Kaplan-Meier estimator and the Cox Proportional Hazards model.
RESULTS
Our cohort included 4,340 high-risk WLHIV, mean (±SD) age 41.8 (±10.2) years. About 18% (763/4,340) had both risk factors, while 9% (374/4,340) had abnormal results on their initial anal cancer screening. The median time, or the time at which 50% of the cohort received follow-up screening, was 17.53 (95% CI = 16.13, 18.30) months overall. Follow-up screening was more common in women with both risk factors for developing anal cancer compared to those with one risk factor (median time: 10.13 [95% CI = 8.90, 11.47] vs. 19.56 [95% CI = 18.36, 21.40] months; adjusted hazard ratio [aHR] = 1.53 [95% CI = 1.38, 1.68]). The follow-up was also more common in women with abnormal results on the initial screening compared to those with a normal result (median time: 7.00 [95% CI = 5.40, 9.23] vs. 18.91 [95% CI = 17.92, 20.12] months; aHR = 2.00 [95% CI = 1.76, 2.28]).
CONCLUSION
Follow-up time for anal cancer screening in high-risk WLHIV was about 1.5 years but varied according to the risk of developing anal cancer. Future research should examine the guideline-concordance of follow-up screening time given the recently issued guidelines for anal cancer screening.
引言
肛门癌筛查有助于二级预防。我们研究了感染艾滋病毒的高危女性（WLHIV）进行肛门癌筛查的随访时间，以及该时间是否因患肛门癌的风险因素数量而异。
方法
一项回顾性队列研究，涉及2009年至2012年期间在美国16个州加哥伦比亚特区参加医疗补助计划至少2年的65岁以下高危WLHIV。高危定义为有宫颈检查结果异常或尖锐湿疣病史。首次肛门癌筛查是高危诊断后的首次筛查，结果分为正常或异常。随访至下次筛查。使用Kaplan-Meier估计器和Cox比例风险模型分析随访时间。
结果
我们的队列包括4340名高危WLHIV，平均（±标准差）年龄41.8（±10.2）岁。约18%（763/4340）有两种风险因素，而9%（374/4340）首次肛门癌筛查结果异常。总体而言，中位时间，即队列中50%的人接受随访筛查的时间为17.53（95%置信区间=16.13，18.30）个月。与有一个风险因素的女性相比，有两种患肛门癌风险因素的女性进行随访筛查更为常见（中位时间：10.13[95%置信区间=8.90，11.47]个月对19.56[95%置信区间=18.36，21.40]个月；调整后风险比[aHR]=1.53[95%置信区间=1.38，1.68]）。与筛查结果正常的女性相比，首次筛查结果异常的女性进行随访也更为常见（中位时间：7.00[95%置信区间=5.40，9.23]个月对18.91[95%置信区间=17.92，20.12]个月；aHR=2.00[95%置信区间=1.76，2.28]）。
结论
高危WLHIV进行肛门癌筛查的随访时间约为1.5年，但因患肛门癌的风险而异。鉴于最近发布的肛门癌筛查指南，未来的研究应检查随访筛查时间与指南的一致性。
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