In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5–42.2,p< 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8–16.7,p= 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1–9.9,p= 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79,p= 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.
2012年，洛桑大学医院（CHUV）腹部外科设立了专门的高分辨率肛门镜检查（HRA）门诊，用于肛门病变的监测与随访。这项为期10年的纵向研究采用结构化筛查方案，对537名患者（共2214次就诊）进行了分析。结果显示，49%的患者检出异型增生病变，其中以低级别鳞状上皮内病变（LSILs）为主（占74%）。在LSIL病例中，6%在24个月内进展为高级别鳞状上皮内病变（HSILs），36个月时累计进展率达25%。在HSIL患者中，3%于48个月后发展为原位癌。值得注意的是，随访期间未观察到浸润性癌变。4例在初次筛查时确诊为鳞状细胞癌的患者接受了放化疗，其中1例需行挽救性手术。研究确定，存在高危型HPV基因型（OR 14.5，95% CI 5–42.2，p<0.001）、可检测到HIV病毒载量（OR 5.4，95% CI 1.8–16.7，p=0.003）以及首次筛查时出现症状（OR 3.2，95% CI 1.1–9.9，p=0.04）是高级别癌前病变（≥HSILs）的独立危险因素。HIV阳性状态与病变进展风险增加呈趋势性关联（OR 2.79，p=0.073）。这些发现强调了在高危人群中开展系统性随访和早期干预对预防肛门癌进展的重要性。
Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic
肿瘤(癌症)患者之家