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)

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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

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