What Is the Risk of Anal Carcinoma in Patients With Anal Intraepithelial Neoplasia III?
| Autor: | Liliana Bordeianou, Lieba R. Savitt, Rocco Ricciardi, Todd D. Francone, Caitlin Stafford, Grace C. Lee, Holly Milch, Hiroko Kunitake |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Ablation Techniques
Adult Male medicine.medical_specialty Time Factors Anal Carcinoma Population Risk Assessment Gastroenterology Article 03 medical and health sciences Sex Factors 0302 clinical medicine Risk Factors Internal medicine Carcinoma medicine Humans Anal cancer education Neoplasm Staging Retrospective Studies education.field_of_study Marital Status medicine.diagnostic_test business.industry Carcinoma in situ Age Factors Anal Squamous Cell Carcinoma Anoscopy Neoplasms Second Primary Retrospective cohort study General Medicine Middle Aged Anus Neoplasms medicine.disease United States 030220 oncology & carcinogenesis Carcinoma Squamous Cell Disease Progression Female 030211 gastroenterology & hepatology business Carcinoma in Situ SEER Program |
| Zdroj: | Diseases of the Colon & Rectum. 61:1350-1356 |
| ISSN: | 0012-3706 |
| Popis: | Background The risk of anal carcinoma after previous diagnosis of anal intraepithelial neoplasia III is unclear. Objective The purpose of this study was to estimate the risk of anal carcinoma in patients with anal intraepithelial neoplasia III and to identify predictors for subsequent malignancy. Design This was a retrospective review using the Surveillance, Epidemiology, and End Results registry (1973-2014). Setting The study was composed of population-based cancer registries from the United States. Patients Patients who were diagnosed with anal intraepithelial neoplasia III were included. Main outcome measures The primary outcome was rate of subsequent anal squamous cell carcinoma. Predictors for anal cancer were identified using logistic regression and Cox proportional hazard models. Results A total of 2074 patients with anal intraepithelial neoplasia III were identified and followed for a median time of 4.0 years (interquartile range, 1.8-6.7 y). Of the cohort, 171 patients (8.2%) subsequently developed anal cancer. Median time from anal intraepithelial neoplasia III diagnosis to anal cancer diagnosis was 2.7 years (interquartile range, 1.1-4.5 y). Fifty-two patients (30.4%) who developed anal carcinoma were staged T2 or higher. Ablative therapies for initial anal intraepithelial neoplasia III were associated with a reduction in the risk of anal cancer (OR = 0.3 (95% CI, 0.1-0.7); p = 0.004). Time-to-event analysis revealed that the 5-year incidence of anal carcinoma after anal intraepithelial neoplasia III was 9.5% or ≈1.9% per year. Limitations The registry did not record HIV status, surveillance schedule, use of high-resolution anoscopy, or provider specialty. Conclusions In the largest published cohort of patients with anal intraepithelial neoplasia III, ≈10% of patients were projected to develop anal cancer within 5 years. Nearly one third of anal cancers were diagnosed at stage T2 or higher despite a previous diagnosis of anal intraepithelial neoplasia III. Ablative procedures were associated with a decreased risk of cancer. This study highlights the considerable rate of malignancy in patients with anal intraepithelial neoplasia III and the need for effective therapies and surveillance. See Video Abstract at http://links.lww.com/DCR/A764. |
| Databáze: | OpenAIRE |
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