ArticleDiseases of the colon and rectum2018
Expectant Management of High-Grade Anal Dysplasia in People with HIV: Long-term Data.
Article in Diseases of the colon and rectum, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 34 citations in OpenAlex.
- Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer.The New England journal of medicine · 2022Trial
- Anal high-grade squamous intraepithelial lesions: identification, classification, and management.The British journal of surgery · 2026Review
- Anal Squamous Intraepithelial Lesions: A Primer for Gastroenterologists.Current gastroenterology reports · 2025Review
- Sexually transmitted human papillomavirus and related sequelae.Clinical microbiology reviews · 2025Review
- Duration of Time CD4/CD8 Ratio is Below 0.5 is Associated with Progression to Anal Cancer in Patients with HIV and High-Grade Dysplasia.Annals of surgical oncology · 2023Article
- Follow-Up to High-Resolution Anoscopy After Abnormal Anal Cytology in People Living with HIV.AIDS patient care and STDs · 2022Article
- Feasibility and safety study of a high resolution wide field-of-view scanning endoscope for circumferential intraluminal intestinal imaging.Scientific reports · 2021Article
- Article
- Anal squamous intraepithelial lesions: an update and proposed management algorithm.Techniques in coloproctology · 2020Review
- What's wrong with the status quo? Plenty.International journal of colorectal disease · 2019Article
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBoth ablation and expectant management of high-grade squamous intraepithelial lesions have been proposed. Expectant management would be reasonable if 1) the rate of high-grade squamous epithelial lesion progression to anal squamous cell carcinoma were low, and 2) anal squamous cell carcinoma arising under surveillance had a better prognosis than anal squamous cell carcinoma presenting without an identified precursor.
objectiveThis study aims to quantify aspects of high-grade squamous epithelial lesion/anal squamous cell carcinoma clinical evolution in a surgical practice.
designThis is a retrospective cohort study. SETTINGS: This study was performed in 1 colorectal surgeon's practice over a 20-year period. PATIENTS: Consecutive patients with high-grade squamous intraepithelial lesion and anal squamous cell carcinoma were included.
main outcome measuresWe looked at the rate and timing of progression to anal squamous cell carcinoma, and the stage, treatment, and outcome of anal squamous cell carcinoma. We reviewed a comparison group of HIV-positive patients presenting de novo with anal squamous cell carcinoma (no prior history of high-grade squamous intraepithelial lesion).
resultsWith consideration of only HIV-positive patients, 341 patients had a mean 5.6 years follow-up from high-grade squamous intraepithelial lesion diagnosis to the most recent documented anal examination. Twenty-four of these surveillance patients developed anal squamous cell carcinoma, yielding a progression rate of 1.3% per patient-year. Mean follow-up was 7.3 years from the initial cancer diagnosis to the most recent contact. Forty-seven patients who presented de novo with anal squamous cell carcinoma developed 74 lesions, with a mean follow-up of 5.7 years after initial diagnosis. This de novo group had higher anal squamous cell carcinoma-specific mortality (3% per patient-year vs 0.05%). Our study did not show a significantly higher rate of high stage (stage III or IV) at anal squamous cell carcinoma diagnosis in the de novo group in comparison with the surveillance group (25.5% vs 8.3% (p = 0.09)). LIMITATIONS: This study was retrospective in nature and had a predominately male population.
conclusionsThe progression of untreated high-grade squamous intraepithelial lesion to anal squamous cell carcinoma approximates 1% per patient-year. Anal squamous cell carcinoma developing under surveillance tends to be of an earlier stage and to require fewer major interventions than anal squamous cell carcinoma presenting de novo. Cancer-specific mortality was lower for malignancies that developed under surveillance. We suggest that expectant management of patients with high-grade squamous intraepithelial lesion is a rational strategy for preventing anal cancer morbidity. See Video Abstract at http://links.lww.com/DCR/A699.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.