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

• Published in: European journal of surgical oncology Vol. 47; no. 2; pp. 304 - 310
• Main Authors: Knight, Katrina, Al-Wahid, Muhammed, Choong, Jia Xun, Burton, Kevin, Lindsay, Rhona, McKee, Ruth F., Anderson, John H., Roxburgh, Campbell SD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2021
• Subjects: Adult; Anal Canal - pathology; Anus Neoplasms - diagnosis; Anus Neoplasms - therapy; Carcinoma in Situ - diagnosis; Carcinoma in Situ - therapy; Disease Management; Disease Progression; Female; Follow-Up Studies; HIV infections; Humans; Immunosuppressive agents; Male; Middle Aged; Neoplasm Staging; Neoplasms; Proctoscopy - methods; Retrospective Studies; Retrospective studies: disease progression; MuFIN; HIV infections; APR; CRT; HIV; AIN; ASCC; MDT; Retrospective studies: disease progression; Neoplasms; Immunosuppressive agents; HPV
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2020.08.011

To describe the regional burden of AIN and rate of progression to cancer in patients managed in specialist and non-specialist clinic settings.
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.
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.
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.