Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review
Introduction Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those...
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| Veröffentlicht in: | International journal of colorectal disease 2020-10, Vol.35 (10), p.1855-1864 |
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| creator | Power Foley, M. Kelly, M. E. Kerr, C Kennedy, C. Gallagher, D. Gillham, C. Mehigan, B. J. McCormick, P. H. Bergin, C. Larkin, J. O. |
| description | Introduction
Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes.
Methods
Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients.
Results
One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26–88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM).
Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%.
HMSH patients were significantly younger at ASCC diagnosis (
p
< 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%,
p
= 0.037).
Conclusion
ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention. |
| doi_str_mv | 10.1007/s00384-020-03640-9 |
| format | Article |
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Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes.
Methods
Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients.
Results
One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26–88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM).
Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%.
HMSH patients were significantly younger at ASCC diagnosis (
p
< 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%,
p
= 0.037).
Conclusion
ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-020-03640-9</identifier><identifier>PMID: 32500433</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms - diagnosis ; Anus Neoplasms - epidemiology ; Anus Neoplasms - therapy ; Carcinoma in Situ - epidemiology ; Carcinoma in Situ - therapy ; Carcinoma, Squamous Cell - epidemiology ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy ; Colorectal cancer ; Communicable Diseases ; Comparative analysis ; Demography ; Development and progression ; Diagnosis ; Dysplasia ; Female ; Gastroenterology ; Health aspects ; Hepatology ; HIV ; HIV (Viruses) ; HIV Infections - complications ; HIV Infections - epidemiology ; HIV patients ; Homosexuality, Male ; Human immunodeficiency virus ; Human papillomavirus ; Humans ; Infection ; Infectious diseases ; Internal Medicine ; Male ; Malignancy ; Medical referrals ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Recurrence, Local ; Original Article ; Papillomavirus infections ; Papillomavirus Infections - complications ; Papillomavirus Infections - epidemiology ; Papillomavirus Infections - therapy ; Proctology ; Retrospective Studies ; Risk factors ; Risk groups ; Sexual and Gender Minorities ; Sexual behavior ; Squamous cell carcinoma ; Surgeons ; Surgery ; Tertiary Care Centers ; Young Adult</subject><ispartof>International journal of colorectal disease, 2020-10, Vol.35 (10), p.1855-1864</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-990028d0d66526d6becf584da6996ba427207db9421746e8b8b1de85d26c11853</citedby><cites>FETCH-LOGICAL-c442t-990028d0d66526d6becf584da6996ba427207db9421746e8b8b1de85d26c11853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-020-03640-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-020-03640-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32500433$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Power Foley, M.</creatorcontrib><creatorcontrib>Kelly, M. E.</creatorcontrib><creatorcontrib>Kerr, C</creatorcontrib><creatorcontrib>Kennedy, C.</creatorcontrib><creatorcontrib>Gallagher, D.</creatorcontrib><creatorcontrib>Gillham, C.</creatorcontrib><creatorcontrib>Mehigan, B. J.</creatorcontrib><creatorcontrib>McCormick, P. H.</creatorcontrib><creatorcontrib>Bergin, C.</creatorcontrib><creatorcontrib>Larkin, J. O.</creatorcontrib><title>Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Introduction
Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes.
Methods
Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients.
Results
One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26–88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM).
Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%.
HMSH patients were significantly younger at ASCC diagnosis (
p
< 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%,
p
= 0.037).
Conclusion
ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anus Neoplasms - diagnosis</subject><subject>Anus Neoplasms - epidemiology</subject><subject>Anus Neoplasms - therapy</subject><subject>Carcinoma in Situ - epidemiology</subject><subject>Carcinoma in Situ - therapy</subject><subject>Carcinoma, Squamous Cell - epidemiology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy</subject><subject>Colorectal cancer</subject><subject>Communicable Diseases</subject><subject>Comparative analysis</subject><subject>Demography</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Dysplasia</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>HIV</subject><subject>HIV (Viruses)</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>HIV patients</subject><subject>Homosexuality, Male</subject><subject>Human immunodeficiency virus</subject><subject>Human papillomavirus</subject><subject>Humans</subject><subject>Infection</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medical referrals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Original Article</subject><subject>Papillomavirus infections</subject><subject>Papillomavirus Infections - complications</subject><subject>Papillomavirus Infections - epidemiology</subject><subject>Papillomavirus Infections - therapy</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Risk groups</subject><subject>Sexual and Gender Minorities</subject><subject>Sexual behavior</subject><subject>Squamous cell carcinoma</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tertiary Care Centers</subject><subject>Young Adult</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1u1TAQhSMEoreFF2CBLLFhk-K_2A67qoKCVMQG1pZjTy6u8nNrO636RjwmE1KoQAhlEY3nm2PP0amqF4yeMkr1m0ypMLKmnNZUKEnr9lG1Y1LwmnHFH1c7ynRbs7YxR9VxzlcUa6Xl0-pI8IZSKcSu-v7JTW4PI0yFzD3BYiBxKsnBIZZvMESsJ5gPg8vRYTtsSL5e3DgvmXgYBuJd8nGaRwQKcaRAKtGlO5Kgh5QQ9yifgNyiJPYDhOhdgYA39eBLXIVCzOAyZLJMsbzFWwgz9R24hCo3EW6fVU96N2R4fv8_qb6-f_fl_EN9-fni4_nZZe2l5KVuW0q5CTQo1XAVVAe-b4wMTrWt6pzkmlMdulZypqUC05mOBTBN4MozZhpxUr3edA9pvl4gFzvGvG7p0IYlWy4Zms20kIi--gu9mpeE9qxUQ4VgUrcP1N4NYHHjGd31q6g900xKoxsjkDr9B4VfgDH6eYI-4vkfA3wb8GnOGZ22hxRHdN0yatd42C0eFuNhf8bDrm95ef_ipRsh_B75lQcExAZkbE17SA8r_Uf2B-MJxSs</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Power Foley, M.</creator><creator>Kelly, M. E.</creator><creator>Kerr, C</creator><creator>Kennedy, C.</creator><creator>Gallagher, D.</creator><creator>Gillham, C.</creator><creator>Mehigan, B. J.</creator><creator>McCormick, P. H.</creator><creator>Bergin, C.</creator><creator>Larkin, J. O.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20201001</creationdate><title>Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review</title><author>Power Foley, M. ; Kelly, M. E. ; Kerr, C ; Kennedy, C. ; Gallagher, D. ; Gillham, C. ; Mehigan, B. J. ; McCormick, P. H. ; Bergin, C. ; Larkin, J. O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-990028d0d66526d6becf584da6996ba427207db9421746e8b8b1de85d26c11853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anus Neoplasms - diagnosis</topic><topic>Anus Neoplasms - epidemiology</topic><topic>Anus Neoplasms - therapy</topic><topic>Carcinoma in Situ - epidemiology</topic><topic>Carcinoma in Situ - therapy</topic><topic>Carcinoma, Squamous Cell - epidemiology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy</topic><topic>Colorectal cancer</topic><topic>Communicable Diseases</topic><topic>Comparative analysis</topic><topic>Demography</topic><topic>Development and progression</topic><topic>Diagnosis</topic><topic>Dysplasia</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Health aspects</topic><topic>Hepatology</topic><topic>HIV</topic><topic>HIV (Viruses)</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - epidemiology</topic><topic>HIV patients</topic><topic>Homosexuality, Male</topic><topic>Human immunodeficiency virus</topic><topic>Human papillomavirus</topic><topic>Humans</topic><topic>Infection</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medical referrals</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local</topic><topic>Original Article</topic><topic>Papillomavirus infections</topic><topic>Papillomavirus Infections - complications</topic><topic>Papillomavirus Infections - epidemiology</topic><topic>Papillomavirus Infections - therapy</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Risk groups</topic><topic>Sexual and Gender Minorities</topic><topic>Sexual behavior</topic><topic>Squamous cell carcinoma</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tertiary Care Centers</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Power Foley, M.</creatorcontrib><creatorcontrib>Kelly, M. E.</creatorcontrib><creatorcontrib>Kerr, C</creatorcontrib><creatorcontrib>Kennedy, C.</creatorcontrib><creatorcontrib>Gallagher, D.</creatorcontrib><creatorcontrib>Gillham, C.</creatorcontrib><creatorcontrib>Mehigan, B. J.</creatorcontrib><creatorcontrib>McCormick, P. H.</creatorcontrib><creatorcontrib>Bergin, C.</creatorcontrib><creatorcontrib>Larkin, J. O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Power Foley, M.</au><au>Kelly, M. E.</au><au>Kerr, C</au><au>Kennedy, C.</au><au>Gallagher, D.</au><au>Gillham, C.</au><au>Mehigan, B. J.</au><au>McCormick, P. H.</au><au>Bergin, C.</au><au>Larkin, J. O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>35</volume><issue>10</issue><spage>1855</spage><epage>1864</epage><pages>1855-1864</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Introduction
Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes.
Methods
Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients.
Results
One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26–88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM).
Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%.
HMSH patients were significantly younger at ASCC diagnosis (
p
< 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%,
p
= 0.037).
Conclusion
ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32500433</pmid><doi>10.1007/s00384-020-03640-9</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2020-10, Vol.35 (10), p.1855-1864 |
| issn | 0179-1958 1432-1262 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2410361734 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aged, 80 and over Anus Neoplasms - diagnosis Anus Neoplasms - epidemiology Anus Neoplasms - therapy Carcinoma in Situ - epidemiology Carcinoma in Situ - therapy Carcinoma, Squamous Cell - epidemiology Carcinoma, Squamous Cell - therapy Chemoradiotherapy Colorectal cancer Communicable Diseases Comparative analysis Demography Development and progression Diagnosis Dysplasia Female Gastroenterology Health aspects Hepatology HIV HIV (Viruses) HIV Infections - complications HIV Infections - epidemiology HIV patients Homosexuality, Male Human immunodeficiency virus Human papillomavirus Humans Infection Infectious diseases Internal Medicine Male Malignancy Medical referrals Medicine Medicine & Public Health Middle Aged Neoplasm Recurrence, Local Original Article Papillomavirus infections Papillomavirus Infections - complications Papillomavirus Infections - epidemiology Papillomavirus Infections - therapy Proctology Retrospective Studies Risk factors Risk groups Sexual and Gender Minorities Sexual behavior Squamous cell carcinoma Surgeons Surgery Tertiary Care Centers Young Adult |
| title | Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review |
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