NEJM:对于HIV患者,比主动监测更有效,可将肛门癌进展率减半的操作是......

2022-06-19 MedSci原创 MedSci原创

N Engl J Med:治疗肛门高级别鳞状上皮内病变以预防肛门癌

人类免疫缺陷病毒(HIV)感染者的肛门癌发病率大大高于一般人群。与宫颈癌类似,肛门癌的癌前病变是高级别鳞状上皮内病变(HSILs)。宫颈高级别鳞状上皮内病变的治疗可减少进展为宫颈癌的患者;然而,关于治疗肛门高级别鳞状上皮内病变以预防肛门癌的前瞻性研究资料目前十分缺乏。

本研究在美国的25个地点进行了3期试验。年龄在35岁及以上、经活检证实肛门高级别鳞状上皮内病变的艾滋病毒感染者按11的比例,随机分配到接受高级别鳞状上皮内病变治疗或不治疗的主动监测。治疗包括以诊室为基础的消融手术,麻醉下的消融或切除,或局部使用氟尿嘧啶或咪喹莫特。主要结局是在事件发生时间分析中进展为肛门癌。治疗组的参与者接受治疗,直到HSIL完全解决。所有参与者至少每6个月接受一次高分辨率的肛门镜检查;对于治疗组怀疑正在进行的高级别鳞状上皮内病变(HSIL),主动监测组每年进行一次活检,或任何有癌症担忧的时候进行活检。

在接受随机化的4459名参与者中,有4446名(99.7%)被纳入癌症进展时间的分析中。中位随访时间为25.8个月,治疗组诊断出9例(每100000人年173例;95%可信区间[CI]90332例),主动监测组21例(每100000人年402例;95%CI262616例)。治疗组进展为肛门癌的比率比主动监测组低57%95%CI680P=0.03 log-rank检验P=0.03)。

总的来说,在活检证实的肛门高级别鳞状上皮内病变的参与者中,治疗肛门高级别鳞状上皮内癌变的风险明显低于主动监测的参与者。

原文来源:

Palefsky JM, Lee JY, Jay N, Goldstone SE, Darragh TM, Dunlevy HA, Rosa-Cunha I, Arons A, Pugliese JC, Vena D, Sparano JA, Wilkin TJ, Bucher G, Stier EA, Tirado Gomez M, Flowers L, Barroso LF, Mitsuyasu RT, Lensing SY, Logan J, Aboulafia DM, Schouten JT, de la Ossa J, Levine R, Korman JD, Hagensee M, Atkinson TM, Einstein MH, Cracchiolo BM, Wiley D, Ellsworth GB, Brickman C, Berry-Lawhorn JM; ANCHOR Investigators Group. Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. N Engl J Med. 2022 Jun 16;386(24):2273-2282. doi: 10.1056/NEJMoa2201048. PMID: 35704479.

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    2022-11-09 hxj0127
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    2022-06-16 小元

    NEJM上果然牛,感谢梅斯更新及时

    0

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