SNFGE SNFGE
 
Thématique :
- Coloproctologie
- Cancers autres (hors CCR et CHC)
Originalité :
Réexamen
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Sylvain MANFREDI
Coup de coeur :
 
 
Digestive and Liver Disease
  2016/07  
 
  2016 Jul;48(7):806-11  
  doi: 10.1016/j.dld.2016.03.011  
 
  High-grade anal intraepithelial neoplasia: Progression to invasive cancer is not a certainty  
 
  Gautier M, Brochard C, Lion A, Henno S, Mallet AL, Bodere A, Bouguen G, Lièvre A, Siproudhis L  
  https://www.ncbi.nlm.nih.gov/pubmed/27103359  
 
 

BACKGROUND:

The incidences of high-grade anal intraepithelial neoplasia (HSIL) and superficially invasive squamous cell carcinomas (SISCCA) related to human papillomavirus (HPV) have increased. These lesions can progress to invasive anal cancer. The aim of the study was to assess the clinical outcome with a special focus on the healing rate.

METHODS:

Forty-six consecutive patients (M/F: 35/11; HIV+: 30) with histologically proven HSIL lesions (N=41) or SISCCA (N=5) were enrolled in a follow-up survey.

RESULTS:

Of the 46 patients, 40 were treated by excision (n=9), electrocoagulation (n=13), topical treatment (n=2) or combined strategies (n=16). After a mean follow-up of 35 (27-43) months, only one patient progressed to an invasive cancer. Regression and healing were observed in 14 (30%) and 15 (33%) patients. The cumulative probabilities of healing were 14%, 49% and 74% after 1, 3 and 5 years. None of the current smokers healed. Heterosexual patients, sexual abstinence, patients older than 44 years old, non-smokers, patients without any past history of condyloma and those with less than 2 high-risk HPVs at baseline were more likely to heal.

CONCLUSION:

Progression to invasive cancer is a rare event. Large, prospective cohort studies are needed to plan coherent strategies for both follow-up and treatment.

 
Question posée
 
La dysplasie anale intra-épithéliale de haut grade évolue-t-elle systématiquement vers un cancer ?
 
Question posée
 
Suivi prospectif de 46 patients traités par divers traitements. L’apparition d’un cancer est un évènement rare. Ces patients peuvent être traités par traitement local + surveillance
 
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