High-grade anal intraepithelial neoplasia: Progression to invasive cancer is not a certainty.
BACKGROUND
The incidences of high-grade anal intraepithelial neoplasia (HSIL) and superficially invasive squamous cell carcinomas (SISCCA) related to human papillomavirus (HPV) have increased. These lesions can progress to invasive anal cancer. The aim of the study was to assess the clinical outcome with a special focus on the healing rate.


METHODS
Forty-six consecutive patients (M/F: 35/11; HIV+: 30) with histologically proven HSIL lesions (N=41) or SISCCA (N=5) were enrolled in a follow-up survey.


RESULTS
Of the 46 patients, 40 were treated by excision (n=9), electrocoagulation (n=13), topical treatment (n=2) or combined strategies (n=16). After a mean follow-up of 35 (27-43) months, only one patient progressed to an invasive cancer. Regression and healing were observed in 14 (30%) and 15 (33%) patients. The cumulative probabilities of healing were 14%, 49% and 74% after 1, 3 and 5 years. None of the current smokers healed. Heterosexual patients, sexual abstinence, patients older than 44 years old, non-smokers, patients without any past history of condyloma and those with less than 2 high-risk HPVs at baseline were more likely to heal.


CONCLUSIONS
Progression to invasive cancer is a rare event. Large, prospective cohort studies are needed to plan coherent strategies for both follow-up and treatment.
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Mathilde
M
Gautier
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France; CIC-1414 University Hospital of Rennes, Pontchaillou, France.
Charlène
C
Brochard
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Annie
A
Lion
CIC-1414 University Hospital of Rennes, Pontchaillou, France; Department of Pathology, University Hospital of Rennes, Pontchaillou, France.
Sébastien
S
Henno
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Anne Laure
AL
Mallet
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Anaïs
A
Bodere
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France; CIC-1414 University Hospital of Rennes, Pontchaillou, France.
Guillaume
G
Bouguen
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France.
Astrid
A
Lièvre
Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France; CIC-1414 University Hospital of Rennes, Pontchaillou, France. Electronic address: laurent.siproudhis@chu-rennes.fr.
Laurent
L
Siproudhis
D001005:Anus Neoplasms / Q000473:pathology* / Q000821:virology; D002278:Carcinoma in Situ / Q000473:pathology* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000821:virology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000473:pathology*
Age; Anal cancer; Cancer; HIV; Healing; High-grade intraepithelial neoplasia; Human papillomavirus; Smoking