Burden of anal squamous cell carcinoma, squamous intraepithelial lesions and HPV16 infection in solid organ transplant recipients: A systematic review and meta‐analysis

• Published in: American journal of transplantation Vol. 20; no. 12; pp. 3520 - 3528
• Main Authors: Albuquerque, Andreia, Stirrup, Oliver, Nathan, Mayura, Clifford, Gary M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-12-2020
• Subjects: Anus Neoplasms - epidemiology; Anus Neoplasms - etiology; cancer/malignancy/neoplasia; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - etiology; clinical research/practice; Colorectal cancer; complication: infectious; complication: malignant; Cytology; Human papillomavirus; Human papillomavirus 16; Humans; Immunosuppression; immunosuppression/immune modulation; infection and infectious agents – viral; infectious disease; Lesions; Life span; Meta-analysis; Organ Transplantation - adverse effects; organ transplantation in general; Papillomavirus Infections - epidemiology; Squamous cell carcinoma; Squamous Intraepithelial Lesions; Statistical analysis; Systematic review; complication: malignant; immunosuppression/immune modulation; infectious disease; organ transplantation in general; clinical research/practice; cancer/malignancy/neoplasia; infection and infectious agents - viral; complication: infectious
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15942

The number of solid organ transplant recipients (SOTR), and their life expectancy, is increasing, with higher risk for long‐term complications from immunosuppression. We carried out a systematic review describing the burden of anal squamous cell carcinoma (SCC), and its surrogates, in SOTR. We conducted mixed effect model‐based meta‐analyses evaluating incidence of anal SCC (standardized incidence ratio [SIR] vs general population, and absolute incidence rate [IR]), prevalence of anal squamous abnormalities, and human papillomavirus (HPV) 16. Generalized I2 statistics were calculated, quantifying heterogeneity. Anal SCC incidence in SOTR was elevated vs the general population (pooled SIR = 6.8, 95% confidence interval [CI], 4.3‐10.9; 6 studies including 241 106 SOTR; I2 = 82.3%), with an absolute IR of 12.3 (95% CI, 10.4‐14.7) per 100 000 person‐years (5 studies including 1 079 489 person‐years; I2 = 0%). Prevalence of abnormal anal cytology was 12.9% (95% CI, 9.2%‐17.7%; 6 studies including 328 SOTR; I2 = 17.4%). For histology, the pooled prevalence estimate of anal squamous intraepithelial lesions was 22.4% (95% CI, 17.3%‐28.5%; 3 studies including 214 SOTR; I2 = 0%), with 4.7% (95% CI, 2.5%‐8.5%; I2 = 0%) high‐grade squamous intraepithelial lesions. Pooled anal HPV16 prevalence was 3.6% (95% CI, 1.6%‐7.8%; 4 studies including 254 SOTR; I2 = 17.6%). There was substantial and consistent evidence of elevated anal SCC incidence in SOTR.
A systematic review and meta‐analysis evaluating the burden of anal squamous cell carcinoma and its surrogates show substantial and consistent evidence that the incidence of anal squamous cell carcinoma is increased in solid organ transplant recipients.