High-grade intraepithelial lesions of the anus—patience: A road to wisdom

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-03-03 DOI:10.1111/codi.70053

C. Gouriou, A. Landemaine, A. Carlo, E. Boisteau, S. Henno, V. Thibault, A. Lievre, L. Siproudhis, C. Brochard

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Abstract

Aim

The progression of high-grade squamous intraepithelial lesions (HSILs) to anal cancer is feared. Data on the remission of HSILs are scarce, and factors associated with remission have not been identified. The aims of this study were to determine the rate of remission of HSILs and to identify factors associated with remission.

Method

Consecutive patients with HSILs referred to a tertiary proctology unit for monitoring were identified in a prospective database. Clinical data, as well as cytological, histological and treatment data, were recorded. The remission of HSILs was defined by the normality of the macroscopic examination and the normal histology and/or cytology of at least two consecutive samples.

Results

Overall, 144 patients with HSILs were followed for 4.1 (2.1–6.5) years. The cumulative probabilities of remission of HSILs were 9.7% (6.2%–14.9%), 14.6% (10.1%–20.7%) and 23.8% (17.3%–31.8%) at 2, 3 and 5 years, respectively. Human papillomavirus 16 (HPV16) clearance was achieved in 19/84 (22.6%) patients. Multivariate analysis revealed that three main factors were associated with remission of HSILs: absence of HPV16 at referral [hazard ratio (HR) 0.3, 95% CI 0.1–0.9], location (absence of endoanal lesion) of HSILs (HR 0.1, 95% CI 0.01–0.08) and excision of HSILs (HR 3.2, 95% CI 1.1–9.0).

Conclusion

The remission of HSILs was not a frequent event in this long-term cohort study. HPV16 is a pejorative factor, while other high-risk HPVs are not. Excision of the HSIL, when possible, could be a preferred treatment to allow better remission.

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肛门上皮内高级别病变--耐心：通往智慧之路

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.