Zusammenfassung
Die Inzidenz des Analkarzinoms nimmt weltweit zu, vor allem bei männlichen homosexuellen Patienten. Als hauptsächlicher Risikofaktor für die Entstehung des Analkarzinoms gilt die anale Infektion mit dem humanen Papillomavirus (HPV). Die Prävalenz der analen HPV-Infektion bei HIV-negativen homosexuellen Männern beträgt 50–60%. Bei HIV-positiven homosexuellen Männern liegt die Prävalenz bei nahezu 100%. Die HPV-assoziierte anale intraepitheliale Neoplasie (AIN) gilt als Vorläuferläsion des Analkarzinoms. Bei etwa 20% der HIV-negativen homosexuellen Männer lässt sich eine AIN diagnostizieren, wobei bei 5–10% eine hochgradige Epitheldysplasie (AIN II–III) vorkommt. Die Prävalenz der hochgradigen AIN ist jedoch mit bis zu 50% bei HIV-positiven homosexuellen Patienten bedeutend höher. Trotz der Häufigkeit von HPV-bedingten analen Epitheldysplasien und der zunehmenden Fälle von Analkarzinomen gibt es aber noch immer keinen Konsens bezüglich des Screenings, der Therapie und der Überwachung von Patienten mit AIN. Im Falle eines Analkarzinoms ist unabhängig vom HPV- oder HIV-Status heute noch immer die Radiochemotherapie mit 5-FU und Mitomycin C Standard.
Abstract
The incidence of anal cancer is increasing worldwide, especially in male homosexual patients. The main risk factor for development of anal cancer is anal infection with the human papillomavirus (HPV). The prevalence of anal HPV infection in HIV-negative homosexual men is 50–60%, while in HIV-positive homosexual men the prevalence is nearly 100%. HPV-related anal intraepithelial neoplasia (AIN) is the putative precursor of anal cancer. AIN can be found in approximately 20% of HIV-negative homosexual men and 5–10% of these patients have high-grade dysplasia (AIN II–III). The prevalence of high-grade dysplasia in HIV-positive homosexual men is, however, significantly higher being up to 50%. Despite the prevalence of HPV-related anal dysplasia and the increasing number of patients with anal cancer, there is still a lack of consensus regarding screening, surveillance and therapy of patients with AIN. The standard treatment for anal cancer is still radiochemotherapy with 5-FU and mitomycin C independent of the HPV or HIV status.
Literatur
Schiffmann M, Castle PE, Jeronimo J et al (2007) Human papillomavirus and cervical cancer. Lancet 370 (9590): 890–907
Johnson LG, Madeleine MM, Newcomer LM et al (2004) Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 101: 281–288
Daling JR, Madeleine MM, Johnson LG et al (2004) Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 101: 270–280
Holly EA, Whittemore AS, Aston DA et al (1989) Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. J Natl Cancer Inst 81: 1726–1731
Cress RD, Holly EA (2003) Incidence of anal cancer in California: increased incidence among men in San Francisco, 1973–1999. Prev Med 36: 555–560
Melbye M, Rabkin C, Frisch M, Biggar RJ (1994) Changing patterns of anal cancer incidence in the United States, 1940–1989. Am J Epidemiol 139: 772–780
D’Souza G, Wiley DJ, Li X et al (2008) Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr 48: 491–499
Diamond C, Taylor TH, Aboumrad T et al (2005) Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapy. Sex Transm Dis 32: 314–320
Adami J, Gäbel H, Lindelöf B et al (2003) Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer 89: 1221–1227
Melbye M, Sprøgel P (1991) Aetiological parallel between anal cancer and cervical cancer. Lancet 338: 657–659
Palefsky JM, Holly EA, Ralston ML et al (1998) High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS 12: 495–503
Schiffman MH (1992) Recent progress in defining the epidemiology of human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst 84: 394–398
Chin-Hong PV, Vittinghoff E, Cranston RD et al (2005) Age-related prevalence of anal cancer precursors in homosexual men: the EXPLORE study. J Natl Cancer Inst 97: 896–905
Palefsky JM, Holly EA, Ralston ML et al (2001) Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women. J Infect Dis 183: 383–391
Hernandez BY, McDuffie K, Zhu X et al (2005) Anal human papillomavirus infection in women and its relationship with cervical infection. Cancer Epidemiol Biomarkers Prev 14: 2550–2556
Palefsky JM, Holly EA, Ralston ML, Jay N (1998) Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men. J Infect Dis 177: 361–367
Palefsky JM, Holly EA, Efirdc JT et al (2005) Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men. AIDS 19: 1407–1414
Kreuter A, Potthoff A, Brockmeyer NH et al (2010) Anal carcinoma in HIV-positive men: results of a prospective study from Germany. Br J Dermatol (Epub ahead of print)
Hessol NA, Holly EA, Efird JT et al (2009) Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women. AIDS 23: 59–70
Frisch M, Fenger C, van den Brule AJ et al (1999) Variants of squamous cell carcinoma of the anal canal and perianal skin and their relation to human papillomaviruses. Cancer Res 59: 753–757
Goldie SJ, Kuntz KM, Weinstein MC et al (1999) The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA 281: 1822–1829
Goldie SJ, Kuntz KM, Weinstein MC et al (2000) Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men. Am J Med 108: 634–641
Nahas CS, Silva Filho EV da, Segurado AA et al (2009) Screening anal dysplasia in HIV-infected patients: is there an agreement between anal pap smear and high-resolution anoscopy-guided biopsy? Dis Colon Rectum 52: 1854–1860
Watson AJ, Smith BB, Whitehead MR et al (2006) Malignant progression of anal intra-epithelial neoplasia. ANZ J Surg 76: 715–717
Dindo D, Nocito A, Schettle M et al (2010) What should we do about anal condyloma and anal intraepithelial neoplasia? Results of a survey. Colorectal Dis (Epub ahead of print)
Scholefield JH, Castle MT, Watson NF (2005) Malignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 92: 1133–1136
Mahto M, Nathan M, O’Mahony C (2010) More than a decade on: review of the use of imiquimod in lower anogenital intraepithelial neoplasia. Int J STD AIDS 21: 8–16
Hoyme UB, Hagedorn M, Schindler AE et al (2002) Effect of adjuvant imiquimod 5% cream on sustained clearance of anogenital warts following laser treatment. Infect Dis Obstet Gynecol 10: 79–88
Chang GJ, Berry JM, Jay N et al (2002) Surgical treatment of high-grade anal squamous intraepithelial lesions: a prospective study. Dis Colon Rectum 45: 453–458
(n a) (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348: 1049–1054
Bartelink H, Roelofsen F, Eschwege F et al (1997) Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 15: 2040–2049
Ortholan C, Ramaioli A, Peiffert D et al (2005) Anal canal carcinoma: early-stage tumors <or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 62: 479–485
Ajani JA, Winter KA, Gunderson LL et al (2008) Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 299: 1914–1921
James R, Wan S, Glynne-Jones R et al (2009) A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). J Clin Oncol 27: 18 s (ASCO abstract)
Salama JK, Mell LK, Schomas DA et al (2007) Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol 25: 4581–4586
Newlin HE, Zlotecki RA, Morris CG et al (2004) Squamous cell carcinoma of the anal margin. J Surg Oncol 86: 55–62; discussion 63
Oehler-Janne C, Huguet F, Provencher S et al (2008) HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy. J Clin Oncol 26: 2550–2557
Seo Y, Kinsella MT, Reynolds HL et al (2009) Outcomes of chemoradiotherapy with 5-Fluorouracil and mitomycin C for anal cancer in immunocompetent versus immunodeficient patients. Int J Radiat Oncol Biol Phys 75: 143–149
Hoffman R, Welton ML, Klencke B et al (1999) The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys 44: 127–131
Blazy A, Hennequin C, Gornet JM et al (2005) Anal carcinomas in HIV-positive patients: high-dose chemoradiotherapy is feasible in the era of highly active antiretroviral therapy. Dis Colon Rectum 48: 1176–1181
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Dindo, D., Riesterer, O., Weber, A. et al. Humanes Papillomavirus und Analkarzinom. Gastroenterologe 5, 318–325 (2010). https://doi.org/10.1007/s11377-010-0400-5
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DOI: https://doi.org/10.1007/s11377-010-0400-5