Multidisciplinary management of anal intraepithelial neoplasia and rate of progression to cancer: a retrospective cohort study

Knight, K., Al-Wahid, M., Choong, J. X., Burton, K., Lindsay, R., McKee, R. F., Anderson, J. H. and Roxburgh, C. S.D. (2021) Multidisciplinary management of anal intraepithelial neoplasia and rate of progression to cancer: a retrospective cohort study. European Journal of Surgical Oncology, 47(2), pp. 304-310. (doi: 10.1016/j.ejso.2020.08.011) (PMID:32873453)

Abstract

Purpose: To describe the regional burden of AIN and rate of progression to cancer in patients managed in specialist and non-specialist clinic settings. Methods: Patients with a histopathological diagnosis of AIN between 1994 and 2018 were retrospectively identified. Clinicopathological characteristics including high-risk status (chronic immunosuppressant use or HIV positive), number and type of biopsy (punch/excision) and histopathological findings were recorded. The relationship between clinicopathological characteristics and progression to cancer was assessed using logistic regression. Results: Of 250 patients identified, 207 were eligible for inclusion: 144 from the specialist and 63 from the non-specialist clinic. Patients in the specialist clinic were younger (<40 years 31% vs 19%, p = 0.007), more likely to be male (34% vs 16%, p = 0.008) and HIV positive (15% vs 2%, p = 0.012). Patients in the non-specialist clinic were less likely to have AIN3 on initial pathology (68% vs 79%, p = 0.074) and were more often followed up for less than 36 months (46% vs 28%, p = 0.134). The rate of progression to cancer was 17% in the whole cohort (20% vs 10%, p = 0.061). On multivariate analysis, increasing age (OR 3.02, 95%CI 1.58–5.78, p < 0.001), high risk status (OR 3.53, 95% CI 1.43–8.74, p = 0.006) and increasing number of excisions (OR 4.88, 95%CI 2.15–11.07, p < 0.001) were related to progression to cancer. Conclusion: The specialist clinic provides a structured approach to the follow up of high-risk status patients with AIN. Frequent monitoring with specialist assessments including high resolution anoscopy in a higher volume clinic are required due to the increased risk of progression to anal cancer.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Roxburgh, Professor Campbell and McKee, Dr Ruth and Lindsay, Dr Rhona and Knight, Miss Katrina

Creator Roles

Knight, K.: Data curation, Writing – original draft
Lindsay, R.: Writing – review and editing
McKee, R. F.: Conceptualization, Writing – review and editing
Roxburgh, C. S.D.: Conceptualization, Writing – review and editing, Supervision

• Authors: Knight, K., Al-Wahid, M., Choong, J. X., Burton, K., Lindsay, R., McKee, R. F., Anderson, J. H., and Roxburgh, C. S.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Journal of Surgical Oncology
• Publisher: Elsevier
• ISSN: 0748-7983
• ISSN (Online): 1532-2157
• Published Online: 19 August 2020
• Copyright Holders: Crown Copyright © 2020 Published by Elsevier Ltd
• First Published: First published in European Journal of Surgical Oncology 47(2): 32873453
• Publisher Policy: Reproduced in accordance with the publisher copyright policy