High-Grade Anal Intraepithelial Neoplasia: Progression to Invasive Cancer Is Not a Certainty

Mathilde Gautier (1, 2) , Charlène Brochard (3, 4, 2) , Annie Lion (2) , Sébastien Hénno (5, 3) , Anne Laure Mallet (2) , Anaïs Bodere (2) , Guillaume Bouguen (2, 3, 4) , Astrid Lièvre (2, 6) , Laurent Siproudhis (4, 2, 3)

1 Centre de référence des surcharges en fer rares d'origine génétique
2 Service des Maladies de l'Appareil Digestif [CHU Rennes]
3 CIC - Centre d'Investigation Clinique [Rennes]
4 Foie, métabolismes et cancer
5 Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes]
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]

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.Conclusion Progression to invasive cancer is a rare event. Large, prospective cohort studies are needed to plan coherent strategies for both follow-up and treatment

Mots clés: Smoking; human papillomavirus; HIV; condylomas; age; anal cancer; Cancer; healing; high-grade intraepithelial neoplasia; MSM; regression; sexual life

Domaines: Cancer; Hépatologie et Gastroentérologie

Mathilde Gautier, Charlène Brochard, Annie Lion, Sébastien Hénno, Anne Laure Mallet, et al.. High-Grade Anal Intraepithelial Neoplasia: Progression to Invasive Cancer Is Not a Certainty. Digestive and Liver Disease, 2016, 48 (7), pp.806-811. ⟨10.1016/j.dld.2016.03.011⟩. ⟨hal-01295666⟩