Long-term outcome of ablation for anal HSIL: Achieving HSIL-free status is key-A UK-based retrospective cohort study.
Treating anal high-grade squamous intraepithelial lesions (HSIL) reduces squamous cell carcinoma (SCC) rates in high-risk groups such as men having sex with men (MSM), especially those living with HIV (LWH). Follow-up data after HSIL treatment is lacking.
A retrospective analysis was conducted of consecutive male patients with biopsy-proven HSIL undergoing high resolution anoscopy (HRA)-based ablation and subsequent surveillance at a UK specialist centre until either latest HRA or cancer diagnosis. The primary objective was the proportion becoming HSIL-free after treatment. Statistical analysis was carried out using time-to-event analysis with Cox proportional hazards and endpoints of anal cancer and HSIL recurrence.
A total of 136 men, 88% MSM, 78% LWH, underwent surveillance for a median of 5.5 (interquartile range (IQR) 4.0-6.8) years after laser ablation of 188 HSILs of the perianus (26%) or anal canal (74%). After median 1 (IQR 1-2) ablations, 122/136 (90%) patients became HSIL-free (definition: ≥ one HRA with cytology, free of HSIL), median 7 (IQR 5-14) months from index treatment. Fourteen of 136 (10%) patients never became HSIL-free, of whom 5/14 (36%) developed SCC compared to 1/122 (0.8%) who were HSIL-free at least once (p < 0.01). All six patients developing SCC were MSMLWH. Never being HSIL-free was associated with larger index lesions (p < 0.001) and a CD4 nadir of <200 (p < 0.001). At study end, 98/130 without cancer had been HSIL recurrence free (75%) for median 31 (IQR 8-58) months, after total median two ablations (IQR 2-4).
HRA-based treatment of anal HSIL with ablation allows the majority to become HSIL-free. Closer surveillance is needed for those with persisting lesions.
A retrospective analysis was conducted of consecutive male patients with biopsy-proven HSIL undergoing high resolution anoscopy (HRA)-based ablation and subsequent surveillance at a UK specialist centre until either latest HRA or cancer diagnosis. The primary objective was the proportion becoming HSIL-free after treatment. Statistical analysis was carried out using time-to-event analysis with Cox proportional hazards and endpoints of anal cancer and HSIL recurrence.
A total of 136 men, 88% MSM, 78% LWH, underwent surveillance for a median of 5.5 (interquartile range (IQR) 4.0-6.8) years after laser ablation of 188 HSILs of the perianus (26%) or anal canal (74%). After median 1 (IQR 1-2) ablations, 122/136 (90%) patients became HSIL-free (definition: ≥ one HRA with cytology, free of HSIL), median 7 (IQR 5-14) months from index treatment. Fourteen of 136 (10%) patients never became HSIL-free, of whom 5/14 (36%) developed SCC compared to 1/122 (0.8%) who were HSIL-free at least once (p < 0.01). All six patients developing SCC were MSMLWH. Never being HSIL-free was associated with larger index lesions (p < 0.001) and a CD4 nadir of <200 (p < 0.001). At study end, 98/130 without cancer had been HSIL recurrence free (75%) for median 31 (IQR 8-58) months, after total median two ablations (IQR 2-4).
HRA-based treatment of anal HSIL with ablation allows the majority to become HSIL-free. Closer surveillance is needed for those with persisting lesions.
Authors
Cuming Cuming, Rozemeijer Rozemeijer, Farrow Farrow, Cappello Cappello, Wait Wait, Junejo Junejo, Bowring Bowring, Rosenthal Rosenthal, Richel Richel, Nathan Nathan, de Vries de Vries, Prins Prins
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