Long term outcome of treatment of high grade squamous intraepithelial lesions (HSIL) in patients with five years follow up

Background

Office-based or surgical ablation of HSIL may prevent anal cancer; however, limited data exist on long-term outcome regarding HSIL or cancer. It is not established that treating HSIL reduces the incidence of cancer, but long-term remission of HSIL may be a good clinical indicator necessary for cancer prevention.

Methods

Between 2006 and 2008, 369 new patients were diagnosed with HSIL. Follow-up data were extracted in 285/369 patients with HSIL (follow-up not determined in 84). 133 (46.7%) were followed for more than 5 years. As a preliminary analysis, every third patient was analyzed for outcome defined as no HSIL for at least 2 years (HSIL-free) (n=50).

Results

Forty-six patients were men (39 HIV-positive) and 4 were women (1 HIV-positive) ranging in age from 26 to 67 years (mean 45.7 years) and followed from 5.1 to 11.4 years (mean 8.8 years). Patients had between 1–10 (mean 2.58, median 2) ablations to become HSIL-free. Three patients never became HSIL-free; 1 with inadequate follow up and treatment developed cancer at 5.1 years. There was no recurrence of HSIL in 31 patients (62%) followed for 3.2 to 10.1 years (mean 7.0 years). HSIL recurred in 16 patients (32%) at 2.1 to 6.2 years (mean 3.8 years) and only four had another recurrence after becoming HSIL-free.

Conclusions

In patients with more than five years follow-up, 94% became HSIL-free with treatment. Although HSIL recurred in 16 patients, most became HSIL-free. Only 1 patient developed cancer as a result of inadequate treatment. Becoming HSIL-free after ablation may effectively prevent anal cancer.