Anal squamous cell carcinoma in a high HIV prevalence population

Diana Tait,Oliver J Warren,Mark Bower,Christopher C Khoo,Irene Chong,Sarah C Mills,Gianluca Pellino,Christos Kontovounisios,Paris Tekkis,Danielle R L Brogden

doi:10.1007/s12672-021-00397-7

Abstract

Anal Squamous Cell Carcinoma (ASCC) is a rare cancer that has a rapidly increasing incidence in areas with highly developed economies. ASCC is strongly associated with HIV and there appears to be increasing numbers of younger male persons living with HIV (PLWH) diagnosed with ASCC. This is a retrospective cohort study of HIV positive and HIV negative patients diagnosed with primary ASCC between January 2000 and January 2020 in a demographic group with high prevalence rates of HIV. One Hundred and seventy six patients were included, and clinical data was retrieved from multiple, prospective databases. A clinical subgroup was identified in this cohort of younger HIV positive males who were more likely to have had a prior diagnosis of Anal Intraepithelial Neoplasia (AIN). Gender and HIV status had no effect on staging or disease-free survival. PLWH were more likely to develop a recurrence (p < 0.000) but had a longer time to recurrence than HIV negative patients, however this was not statistically significant (46.1 months vs. 17.5 months; p = 0.077). Patients known to have a previous diagnosis of AIN were more likely to have earlier staging and local tumour excision. Five-year Disease-Free Survival was associated with tumour size and the absence of nodal or metastatic disease (p < 0.000).

Highlights

Anal Squamous Cell Carcinoma (ASCC) is considered a rare cancer, with an incidence rate that is frequently quoted as between 1 and 2 cases per 100,000 per year worldwide [1]
Ninety six patients were Human Immunodeficiency Virus (HIV) positive (55%) and 32 patients (18%) were HIV negative. 27% of patients did not have a documented HIV status on retrospective chart review, they were statistically more likely to be female (p < 0.001, Chi Squared) and have a previous diagnosis of Genitourinary Intraepithelial Neoplasia (p = 0.011, Fisher’s Exact Test)
Of the patients with a known HIV status, 75% were people living with HIV (PLWH) in this cohort. 76% of male patients were PLWH whereas only 7% of female patients were PLWH (p < 0.001, Chi Squared). 38% of PLWH included in this cohort had previously met the criteria for AIDS during their treatment for HIV. 38% of PLWH had a concurrent diagnosis of Hepatitis B, 22% Hepatitis C and 10% had both Hepatitis B and C

Summary

Introduction

Anal Squamous Cell Carcinoma (ASCC) is considered a rare cancer, with an incidence rate that is frequently quoted as between 1 and 2 cases per 100,000 per year worldwide [1]. The known risk factors for the development of ASCC include immunosuppression, smoking, receptive anal intercourse, sexually transmitted infections, previous or current Human Papillomavirus (HPV) related dysplasia and malignancies and Human Immunodeficiency Virus (HIV) [3]. It is likely that that the increasing incidence of ASCC related to the higher number of PLWH in developed countries where, in the era of Highly Active Antiretroviral Therapy (HAART), PLWH are able to achieve a near normal life expectancy and go on to develop long-term sequelae of HIV infection [5]. Despite improving outcomes of HIV prognosis with HAART, the use of HAART does not reduce the risk of ASCC in PLWH [4], it is likely that the incidence of ASCC in PLWH will continue to rise [6]

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