Anal Squamous Carcinoma Research Articles

234P Do we need molecular profiling in patients with squamous anal carcinoma?

234P Do we need molecular profiling in patients with squamous anal carcinoma?

Utility of CYP2D6 copy number variants as prognostic biomarker in localized anal squamous cell carcinoma.

Anal squamous cell carcinoma (ASCC) is an infrequent tumor whose treatment has not changed since the 1970s. The aim of this study is the identification of biomarkers allowing personalized treatments and improvement of therapeutic outcomes. Forty-six paraffin tumor samples from ASCC patients were analyzed by whole-exome sequencing. Copy number variants (CNVs) were identified and their relation to disease-free survival (DFS) was studied and validated in an independent retrospective cohort of 101 ASCC patients from the Multidisciplinary Spanish Digestive Cancer Group (GEMCAD). GEMCAD cohort proteomics allowed assessing the biological features of these tumors. On the discovery cohort, the median age was 61years old, 50% were males, stages I/II/III: 3 (7%)/16 (35%)/27 (58%), respectively, median DFS was 33months, and overall survival was 45months. Twenty-nine genes whose duplication was related to DFS were identified. The most representative was duplications of the CYP2D locus, including CYP2D6, CYP2D7P, and CYP2D8P genes. Patients with CYP2D6 CNV had worse DFS at 5years than those with two CYP2D6 copies (21%vs. 84%; p<.0002, hazard ratio [HR], 5.8; 95% confidence interval [CI], 2.7-24.9). In the GEMCAD validation cohort, patients with CYP2D6 CNV also had worse DFS at 5years (56% vs. 87%; p=.02, HR=3.6; 95% CI, 1.1-5.7). Mitochondria and mitochondrial cell-cycle proteins were overexpressed in patients with CYP2D6 CNV. Tumor CYP2D6 CNV identified patients with a significantly worse DFS at 5years among localized ASCC patients treated with 5-fluorouracil, mitomycin C, and radiotherapy. Proteomics pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets for these high-risk patients. Anal squamous cell carcinoma is an infrequent tumor whose treatment has not been changed since the 1970s. However, disease-free survival in late staged tumors is between 40% and 70%. The presence of an alteration in the number of copies of CYP2D6 gene is a biomarker of worse disease-free survival. The analysis of the proteins in these high-risk patients pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets. Therefore, the determination of the number of copies of CYP2D6 allows the identification of anal squamous carcinoma patients with a high-risk of relapse that could be redirected to a clinical trial. Additionally, this study may be useful to suggest new treatment strategies to increase current therapy efficacy.

Accuracy of narrow-band imaging in predicting the histology of anal intraepithelial lesions.

Anal intraepithelial neoplasia (AIN) is the precursor of anal squamous carcinoma, frequently underappreciated by most gastroenterologists. Purpose of the study is to assess the diagnostic accuracy of narrow-band imaging (NBI) in predicting the histology of anal lesions, considering a new NBI classification. This is a retrospective analysis of consecutive patients with suspected anal squamous intraepithelial lesions (SILs) and superficially invasive squamous cell carcinoma (SISCCA) who underwent anorectal-sigmoidoscopy. Three expert endoscopists reviewed all the images collected during colonoscopies in white light and NBI in order to generate a practical classification of three main different NBI patterns. After the modified Delphi process, the final NBI classification, mainly based on intrapapillary capillary loops (IPCL) changes included three different NBI pattern. NBI pattern I: elongation of IPCL toward epithelial surface; NBI pattern 2: thickened and tortuous IPCL; NBI pattern 3: mosaic-like disposition of IPCL. We found that NBI pattern positively correlated to the histologic type of the lesions and tumor grade (Spearman's rho = 0.9671, P = 0.0000). Among 58 anal lesions included, 41/41 (100%) LSILs have been classified as NBI pattern I, 10/11 (90.91%) HSILs as NBI pattern II, 1/11 HSIL as NBI pattern I, 4/4 SISCCA as NBI pattern III and 2/2 invasive cancer as NBI pattern III. Diagnostic accuracy of NBI pattern II or III in predicting histology differentiating HSIL or SISCCA/IC versus LSIL showed a sensitivity of 100%, (95% CI: 92.3-100%) and a specificity of 94.1% (95% CI: 83.8-98.3%). The accuracy of this new NBI score system in predicting the histology of anal lesions showed encouraging data in term of sensitivity and specificity in differentiating HSIL or SISCCA/IC versus LSIL, but the clinical usefulness and application of these findings should be evaluated in a prospective larger study.

Volumetric modulated arc radiotherapy with concomitant chemotherapy for the anal squamous carcinoma: A Welsh experience

Volumetric modulated arc radiotherapy with concomitant chemotherapy for the anal squamous carcinoma: A Welsh experience

Neoadjuvant PD-1 blockade combined with chemotherapy followed by concurrent immunoradiotherapy for locally advanced anal canal squamous carcinoma patients: Antitumor efficacy, safety and biomarker.

e15500 Background: Efficacy and safety of PD-1 inhibitors have been approved for the treatment of metastatic anal squamous cancer patients, but the efficacy of neoadjuvant treatment with PD-1 in anal squamous cancer patients has not yet been defined. We report results for the cohort of patients with locally advanced anal canal squamous carcinoma treated with neoadjuvant PD-1 inhibitor toripalimab and chemotherapy followed by concurrent immunoradiotherapy. Methods: Five locally advanced anal canal squamous carcinoma patients received 4 cycles of neoadjuvant PD-1 inhibitor toripalimab and Docetaxol and Cisplatin chemotherapy followed by concurrent immunoradiotherapy. Whole exome sequencing (WES) and mIHC were performed with the pretreatment tumor tissue for biomarker analysis. Results: Complete clinical response (cCR) was achieved in 4 patients after neoadjuvant treatment before radiotherapy while the other patient achieved near cCR. cCR was achieved in all the 5 patients 3 months after definitive immunoradiotherapy. Grade 3 toxicity was noted in 1 patient. Molecular testing revealed that PD-L1 expression (≥1%) in tumor and CD4/CD163 expression in tumor and paracancerous tissue were positively correlated with tumor shrinkage in the neoadjuvant treatment phase while TMB didn’t appear to significantly impact the response. Conclusions: PD-1 inhibitor combined with chemoradiotherapy has quite promising effect in locally advanced anal canal squamous carcinoma patients, with very mild toxicity. Pretreatment PD-L1 expression is positively correlated with tumor response to PD-1 inhibitor toripalimab and chemotherapy. It is worthy of further investigation in prospective clinical trial.

Prognostic role of ultrasonography staging in patients with anal cancer.

BACKGROUNDCarcinomas of the anal canal are staged according to the size and extent of the disease; however, we propose including a novel ultrasound (US) staging system, based on depth of tumor invasion. In this study the clinical American Joint Committee on Cancer (AJCC) staging guidelines and the US classificationss in patients with anal cancer were compared.AIMTo evaluate the prognostic role of the US staging system in patients with anal cancer.METHODSThe data of 48 patients with anal canal squamous cells carcinoma, observed at our University Hospital between 2007 and 2017, who underwent pre-treatment assessment with pelvic magnetic resonance imaging (MRI), total body computed tomography (CT) scan and endoanal US were retrospectively reviewed. Anal canal tumors were clinically staged according to AJCC, determined by MRI by measurement of the longest tumor diameter, and CT scan. Endoanal US was performed with a high multi-frequency (9-16 MHz), 360° rotational mechanical probe; US classification was based on depth of tumor penetration through the anal wall, according to Giovannini’s study. All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C. After treatment patients were followed-up regularly.RESULTSAt baseline there were 30 and 32 T1-2, 18 and 16 T3-4, 31 and 19 N+ patients classified according to the clinical AJCC and US staging system respectively. After a mean follow-up of 98 months, 38 patients (79.1%) are alive and 28 (58.3%) are disease free. During follow up 20 patients (41.6%) experienced recurrences. After univariate analysis, American Society of Anesthesiologists (ASA) score (P = 0.00000001) and US staging (P = 0.009) were significantly related to disease-free survival (DFS). When overall survival and DFS functions were compared, a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging. By combining the 2 significant prognostic variables, namely the US staging with the ASA score, four risks groups with different prognoses were identified.CONCLUSIONOur findings suggest that US staging may be superior to traditional clinical staging, since it is significantly associated with DFS in anal cancer patients.

Distinguishing between HPV-Associated Metastatic Anal Squamous Cell Cancer and HPV-Associated Oropharyngeal Cancer

The histology and immunohistochemistry (IHC) of primary and metastatic diseases from a human papilloma virus- (HPV-) related anal squamous carcinoma (ASCC) would typically demonstrate the same histology as an HPV-related oropharyngeal squamous carcinoma (OPSCC). However, determining whether a site of squamous cell carcinoma represents distant metastatic ASCC versus a metastatic HPV-related metastasis from an OPSCC to a regional lymph node carries profound prognostic and therapeutic implications. A patient with a history of locally advanced ASCC treated with standard concurrent radiation therapy and chemotherapy in 2015 is described. In 2018, an enlarged supraclavicular lymph node was excised demonstrating squamous cell carcinoma and radiographic staging revealed no other areas suspicious for malignancy. Direct laryngoscopy with operating telescope and biopsies demonstrated squamous cell carcinoma at the tongue base. Described here are assays that might be considered in distinguishing between whether a focus distant from a previously identified ASCC represents metastatic disease or instead a separate primary HPV-related cancer.

A clinical trial with protracted infusion 5-fluorouracil and mitomycin C for localized squamous cell carcinoma of the anus.

Mitomycin C (MMC) plus standard 5-fluorouracil (FU) infusion in weeks 1 and 5 often contributes to radiotherapy interruptions and possibly less-than-ideal outcomes in anal cancer. This study was to evaluate alternative strategies for chemotherapy delivery that might be less toxic or more efficacious, and outcomes of patient-initiated treatment interruption for severe acute toxicity. This was a prospective, nonrandomized study for patients with T1-4N0-3M0 anal squamous carcinoma. Radiotherapy of 54Gy in 30 fractions over 6 weeks was given with infusion FU 300mg/m2 /day for 96hours/week for 6 weeks plus bolus MMC at 10mg/m2 on D1. Fifty patients were recruited (72% female). Median age was 60.5 years (35-84). Forty-seven patients (94%) received 54Gy. Median duration of chemoradiation was 39 days (37-105). Grade 3 and 4 acute toxicity were observed in 66%. Thirty-one percent with severe acute toxicity developed severe late toxicity. Of those who experienced severe late skin toxicity, 29% did not have severe acute toxicity. Disease-free survival at 5 years was 74% (95% confidence interval [CI], 60-84), and at 9 years 61% (95% CI, 46-74). Overall survival at 5 years was 84% (95% CI, 71-92), and at 9 years 67% (95% CI, 50-81). Colostomy-free survival at 5 years was 70% (95% CI, 56-81), and at 9 years 57% (95% CI, 40-72). It is feasible to deliver chemoradiation with bolus MMC and protracted infusion FU for anal cancer. Efficacy and toxicity of this regimen seem similar to conventional chemoradiation with FU/MMC. Acute skin toxicity is not a reliable predictor of severe late skin toxicity.

The acceptability of high resolution anoscopy examination in patients attending a tertiary referral centre

BackgroundHigh resolution anoscopy (HRA) examination is regarded as the best method for the management of anal high grade squamous intraepithelial lesions to prevent anal squamous carcinoma. However, little is known about the acceptability of this procedure. This analysis looks at patient experience of HRA examination and ablative treatment under local anaesthetic.MethodsPatients took part in anonymised feedback of their experience immediately after their HRA examinations and/or treatments. A standard questionnaire was used that included assessment of pain and overall satisfaction scores as well as willingness to undergo future HRA examinations.ResultsFour hundred four (89.4%) responses were received and all responses were analysed. The group consisted of 119 females (29.4%) and 261 males (64.6%) with median age of 45 years (IQR = 19) and 45 years (IQR = 21) respectively, and included 58 new cases, 53 treatment cases and 202 surveillance cases. 158 patients (39.1%) had at least one biopsy during their visits. The median pain score was 2 [Inter Quartile Range (IQR) 3] on a visual analogue scale of 0 to 10, where 0 indicated no pain / discomfort and 10 indicated severe pain. The median pain score was 2 (IQR 2) in men and 4 (IQR = 3) in women [Dunn’s Test = 4.3, p < 0.0001] and 3 (IQR 4.5) in treatment cases. Problematic pain defined as a pain score of ≥7 occurred more frequently in women (14%) than in men (6%), [Chi square test (chi2) = 5.6, p = 0.02]. Patient satisfaction with the care they received, measured on a scale of 0 (not happy) to 10 (very happy) found the median score to be 10 with 76% reporting a score of 10. Out of 360 responses, 98% of women and 99% of men said that they would be willing to have a future HRA examination.ConclusionsIn this cohort, the overall pain scores were low and similar across appointment types. However, women had a higher pain score, including troublesome pain levels. Despite this, both women and men were equally satisfied with their care and were willing to have a future examination. The results of the analysis show that the procedure is acceptable to patient groups. A small number of women may need general anaesthesia for their examinations/treatment.

Requiem for Nigro or is anal squamous carcinoma still a surgical problem: Abdominoperineal excision rather than a defunctioning stoma?

Combined multimodal treatment (CMT) is the preferred treatment for anal squamous carcinoma with radical surgery reserved for treatment failure. Some patients require a defunctioning stoma prior to CMT. Successful closure of such a stoma is unlikely. Abdominoperineal excision (APE) may be suitable as primary treatment in these patients. A retrospective review of all patients with anal squamous carcinoma was undertaken. Patients who required defunctioning colostomies prior to CMT were analysed for potential resectability of tumour prior to CMT and rate of permanent stoma. To evaluate organ preservation in the treatment of anal squamous cancer and the closure rate of pre-treatment, temporary diverting colostomy, thereby assessing whether APE could be offered as primary treatment in those requiring a pre-treatment colostomy. One hundred and twenty-five patients were included of which 58 were males. The mean age was 56 years. 107 were treated with curative intent. Six received primary APE and 12 salvage APE. Thirty (22 males) required pretreatment diverting colostomies. Three (10%) stomas were successfully reversed. Forty-eight (38%) of the 125 completed treatment with a permanent colostomy. Six patients who needed a stoma prior to CMT were deemed resectable. Organ preservation was not possible in about a third of patients. Defunctioning stomas prior to CMT were likely to be permanent. We propose that APE could be considered as an alternative in selective cases where the tumour is resectable with low morbidity and a stoma is indicated.

Human papillomavirus related anal squamous cell carcinoma survival: a systematic review and meta-analysis

Background: Human papillomavirus (HPV) has been identified to be related to progression of anal squamous cell carcinoma (ASCC). However, the results remain controversial. A meta-analysis of epidemiologic studies was therefore conducted to address this issue. Methods: Data were collected from studies comparing overall survival (OS) and disease-free survival (DFS)/disease-specific survival (DSS)/relapse-free survival (RFS)/progression-free survival (PFS) in patients with HPV infection. The electronic databases of MEDLINE and EMBASE were searched from their inception till 30 Apr 2017. Study-specific risk estimates were pooled using a fixed-effects model for OS and DFS/DSS/RFS/PFS. Results: Seven studies involving a total of 488 ASCC cases were included in this meta-analysis. The pooled results showed that HPV infection was significantly associated with improved OS (HR =0.36; 95% CI, 0.22–0.58) and DFS/DSS/RFS/PFS (HR =0.29; 95% CI, 0.18–0.47). The findings from most subgroup analyses were consistent with those from the overall analysis. Conclusions: The meta-analysis indicated that HPV infection may be of prognostic or therapeutic utility in the evaluation of factors contributing to ASCC. Testing tumor specimens for HPV might indirectly affect the treatment decisions.

Pilot study of FMC (5-fluorouracil, mitomycin C, and cisplatin) with radiotherapy for patients with anal cancer.

Concurrent chemoradiotherapy (CRT) is the current standard of treatment for anal squamous carcinoma. However, local or metastatic recurrences remain significant after CRT with 5-fluorouracil (5-FU) and mitomycin C (MMC). Therefore, the present study evaluated the feasibility and efficacy of adding cisplatin to the classic CRT (5-FU, MMC, and radiotherapy). Twenty patients with histologically confirmed squamous cell carcinoma of the anus without metastatic disease were enrolled at Kyungpook National University Medical Center (Daegu, Korea) between January 2005 and December 2014. The CRT comprised of two cycles of 5-FU 750mg/m2 days 1-4, MMC 10mg/m2 day 1, and cisplatin 60mg/m2 day 1 every 4weeks and radiotherapy (59.6Gy in 33 daily fractions). The primary endpoint was to determine the feasibility of FMC, while the secondary endpoints were the pathologic complete response (pCR) rate at 8weeks following the completion of CRT, progression-free survival (PFS), and overall survival (OS). The treatment was generally well tolerated, and all patients received two cycles of FMC chemotherapy. Among the 20 patients, 17 were assessed for their pathologic response and 12 patients (70.6%) achieved pCR. The most common grade 3 or 4 hematologic toxicity was neutropenia (n=3), while the most frequent severe non-hematologic toxicity was radiation dermatitis (n=6, 30%). After a median follow-up duration of 45.5months, the estimated 5-year PFS and overall survival rates were 88.9 and 88.1%, respectively. CRT with two cycles of a FMC regimen was found to be feasible for patients with anal squamous carcinoma. Further study is warranted to evaluate the efficacy of CRT with a FMC regimen.

Unexpected anal squamous cells carcinoma after open hemorrhoidectomy.

We report a case of unexpected anal squamous cells carcinoma found in hemorrhoidectomy specimen. The patient had a 3-year history of prolapsing hemorrhoids. A prolapsing hemorrhoid was present at eleven o'clock in lithotomy. Milligan-Morgan was performed and gross examination of the specimen was unremarkable. Histopathologic evaluation showed noninvasive squamous cells carcinoma. The present case report evidences the opportunity of routine histopathologic analysis of hemorrhoidal specimens particularly in case of long-standing prolapse. Questions arise in the option of those techniques where no specimens are collected or tissue is excised far from deceased area.

P533 Colectomy rate and mortality in hospitalized severe ulcerative colitis patients over the past 40 years

1 dose) and IMM ( 6mos) use was reported. Statistical analysis: data expressed as median (range); Student’s T test, Chi squared test. Results: During the study period, 2387 IBD patients were in follow up: 384 (16%) received anti-TNFs. From 2000 to 2013, 15 IBD patients (9 CD, 6 UC) developed cancer of the lower GI tract (0.62%), including 12 colon cancers (6 UC, 6 CD), 1 ileal adenocarcinoma (1 CD), 1 carcinoid of the appendix (1 CD), 1 anal canal squamous carcinoma (1 CD). Among the 15 IBD-K (7 M), median age at diagnosis of cancer was 51 (28 73) yrs, IBD duration 19 yrs (1 47). CD involved the ileum (I) in 4 patients, the colon (C) in 2 patients and the ileum colon (IC) in 3 patients; UC was distal in 3, left-sided in 1 and total in 2 patients. Among the 15 IBD-K patients, 3 (20%) received anti-TNFs and/or IMM (all 3 received both). These 3 patients developed cancer (2 colon, 1 carcinoid): 2 CD (2 F, age 40 and 54 yrs, CD duration 28 and 26 yrs; fistulizing IC) and 1 UC (1 F, age 30, duration 19 yrs; pancolitis). Among the 384/2387 (16%) IBD patients treated with anti-TNFs during the 13 years follow up, colon cancer developed in 3 (0.78%) (all 3 patients also treated with IMM). Among the 2003/2387 patients never treated with anti-TNFs during the follow up, 12 (0.6%) developed cancer of the lower GI tract, 10 (0.5%) colon cancer (p = ns vs patients treated with anti-TNFs). IBD-C included 30 patients (18 CD, 12 UC; 14 M/16 F, age 54 yrs, range 37 75; CD of the I (n = 13), C (n = 2), IC (n = 3); UC was distal (n = 11), left-sided (n = 1) or total (n = 0). Anti-TNFs were used by a comparable number of IBD patients developing or not cancer (IBD-C n = 6/30; 20% vs IBD-K n = 3/15; 20%). In IBD-C, IMM use was reported in 10 (33%) (combined with anti-TNFs in 2; 6.7%). Conclusions: In a retrospective matched-pair study, a comparable low frequency of colon cancer was observed in IBD patients treated or untreated with anti-TNFs.

Cribado de neoplasia intraepitelial anal en grupos de riesgo: estudio descriptivo sobre hábitos sexuales y otras infecciones de transmisión sexual

BackgroundAnal intraepithelial neoplasia is considered a precursor lesion of anal squamous carcinoma. The population with increased risk of this conditions are immunocompromised individuals, especially HIV-infected, with anal sex practices. The aim of this study was to describe the sexual habits of patients who were seen in sexually transmitted infections (STIs) consult in our service in whom anal cytology was performed as well as the association of anal dysplasia to other STIs. Material and methodsWe performed a retrospective cohort study that included those patients in whom, according to our protocol, anal cytology was performed between 2008 and 2011. Also we conducted a survey on sexual habits and screening for other STIs. Finally, we conducted a descriptive and analytical study assessing bivariate distribution of cytological alterations and grade of anal dysplasia. ResultsA total of 347 anal cytologies were performed, and 48.1% were abnormal. Statistically significant differences were found between the presence of condylomata perianal/endoanal, HIV infection, Chlamydia trachomatis infection and the presence of cytologic alterations. ConclusionThere was a high incidence of anal dysplasia in our group of individuals with risky sexual habits; however, it is probably underdiagnosed due to its subclinical nature and lack of a well-established screening protocol.

Safe ablation of the anal mucosa and perianal skin in rats using Photodynamic Therapy—A promising approach for treating Anal Intraepithelial Neoplasia

Anal Intraepithelial Neoplasia (AIN), a pre-cursor of anal squamous carcinoma, is increasingly detected in individuals with impaired immune function. However, choices for effective, low morbidity treatment are limited. Photodynamic Therapy (PDT) is promising as it is known to ablate more proximal gastrointestinal mucosa with safe healing, without damage to underlying muscle. It can also ablate skin with safe healing and minimal scarring. Pharmacokinetics: Normal rats were sensitised with 200mg/kg 5-aminolaevulinic acid (ALA) and killed 1-8h later. Anal tissues were examined by fluorescence microscopy to quantify the concentration of PPIX (protoporphyrin IX, the active derivative of ALA) in anal mucosa and in the underlying sphincter. PDT: Normal rats were sensitised similarly 3h later, laser light (635 nm) was delivered. Anal canal: 50-150 J/cm using 1cm diffuser fibre; for peri-anal skin, 50-200 J/cm(2), using microlens fibre. In each group, 2 rats were killed 3, 7, 14 and 28 days later and the anal region removed for histological examination. Pharmacokinetics: Peak concentration of PPIX in mucosa was at 3h, peak ratio mucosa: muscle, 6, seen at same time. PDT. Anal canal 50 J/cm: complete mucosal ablation by 3 days, complete regeneration by 28 days. Higher energies caused muscle damage with scarring. Peri-anal skin: 200 J/cm(2); complete ablation of skin, including appendages, complete healing by 28 days. Minimal effect with lower energy. ALA-PDT can ablate anal mucosa and peri-anal skin with safe healing and no underlying damage. However, over treatment can damage the sphincters. This technique is ready to undergo clinical trials.

Anal and perianal squamous carcinomas and high‐grade intraepithelial lesions exclusively associated with “low‐risk” HPV genotypes 6 and 11

Anal squamous cell carcinomas are predominantly associated with high-risk human papillomaviruses (HPVs), particularly HPV 16, similar to cervical, vaginal and vulvar cancers. Although the presence of "low-risk" HPVs, in particular genotypes 6 and 11, have occasionally been reported in various HPV-related anogenital cancers, the overall distribution of these genotypes in the anal canal and perianal tissue may differ to that in the cervix. In addition, although the majority of anal and perianal cancers are associated with HPV, some are not; hence, confirmation of direct association of the virus within a lesion is important. Using laser capture microdissection, anal and perianal invasive carcinomas and high-grade squamous intraepithelial lesions (HSILs) in biopsies previously associated with HPV 6 or 11 alone were isolated from tissue sections and HPV genotype tested. Of seven cases tested, four invasive carcinomas were positive for HPV 6 only, one invasive carcinoma was negative for HPV and two HSILs were positive for HPV 11 only. All samples were confirmed as HPV 16/18 negative using two different DNA targets (E6 and L1). From these results, we confirm that HPV 6 and 11 can occasionally be associated with high-grade lesion and anal cancer.

Recurrent anal squamous carcinoma: Is HPV a risk factor?

e15094 Background: Anal squamous carcinoma (ASC) is a rare cancer, representing only 1.5 to 2% of all gastrointestinal (GI) malignancies. Combined chemo-radiotherapy therapy (CRT) is the treatment of choice with a response rate of 80% and recurrence rate of 10 to 15%. HPV is a risk factor for anal cancer but its role in cancer recurrence is less clear. We conducted a retrospective study to analyze clinical outcome of ASC patients in function of their HPV status. Methods: Patients with non-metastatic ASC treated between 2005-2011 at the Centre Hospitalier de l’Université de Montréal were eligible. Patient characteristics, clinical outcomes, and tumoral HPV status were retrospectively identified. Results: Seventy patients (M:31; F:39) were included in the analysis. The median age of patients was 51 years. Patient and tumor characteristics are shown in the Table. CRT was done in 57 patients. Median follow-up was 37.6 months. Eleven patients had recurrence of whom 10 were HPV-positive. Median TTR was 13.2 months. The 3 deaths related to cancer occurred during the first year of diagnosis. The 3 year overall survival was 90.08%. In multivariate analysis neither the advanced stage of disease nor the HPV-positive status had a statistically significant impact on relapse. Conclusions: In this small cohort, we found a high prevalence of HPV positivity in ASC but HPV infection couldn’t be identified as a risk factor for ASC relapse. Inclusion of men in the HPV vaccination program may help in reducing HPV related ASC. [Table: see text]

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

Comunicazione orale: Robot-assisted rectal resection with total mesorectal excision

Comunicazione orale: Robot-assisted rectal resection with total mesorectal excision