Rectal squamous cell carcinoma in immunosuppressed populations: is this a distinct entity from anal cancer?

Details

• Alternative Title:
  AIDS
• Personal Author:
  COGHILL, Anna E. ; SHIELS, Meredith S. ; RYCROFT, Randi K. ; COPELAND, Glenn ; FINCH, Jack L. ; HAKENEWERTH, Anne M. ; PAWLISH, Karen S. ; ENGELS, Eric A.
• Description:
  Objective
  
  Squamous cell carcinoma (SCC) of the rectum is rare, but as with anal cancer, risk may be increased among immunosuppressed individuals. We assessed risk of rectal SCC in HIV-infected people.
  
  Design
  
  Population-based registry
  
  Methods
  
  We utilized the HIV/AIDS Cancer Match, a linkage of US HIV and cancer registries (1991–2010), to ascertain cases of anal SCC, rectal SCC, rectal non-SCC, and colon non-SCC. We compared risk in HIV-infected persons to the general population using standardized incidence ratios (SIRs) and evaluated risk factors using Poisson regression. We reviewed cancer registry case notes to confirm site and histology for a subset of cases.
  
  Results
  
  HIV-infected persons had an excess risk of rectal SCC compared to the general population (SIR=28.9; 95%CI 23.2–35.6), similar to the increase for anal SCC (SIR=37.3). Excess rectal SCC risk was most pronounced among HIV-infected men who have sex with men (MSM, SIR=61.2). Risk was not elevated for rectal non-SCC (SIR=0.88) or colon non-SCC (SIR=0.63). Individuals diagnosed with AIDS had higher rectal SCC rates than those with HIV-only (incidence rate ratio=1.86; 95%CI 1.04–3.31). Based on available information, one-third of rectal SCCs were determined to be misclassified anal cancer.
  
  Conclusions
  
  HIV-infected individuals, especially with advanced immunosuppression, appear to have substantially elevated risk for rectal SCC. As for anal SCC, rectal SCC risk was highest in MSM, pointing to involvement of a sexually transmitted infection such as human papillomavirus. Site misclassification was present, and detailed information on tumor location is needed to prove that rectal SCC is a distinct entity.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Anus Neoplasms Carcinoma, Squamous Cell Female HIV Infections Humans Immunocompromised Host Incidence Male Middle Aged Rectal Neoplasms Risk Factors

  More +
• Source:
  AIDS. 30(1):105-112.
• Pubmed ID:
  26372482
• Pubmed Central ID:
  PMC4703472
• Document Type:
  Journal Article
• Funding:
  U58 DP003931/DP/NCCDPHP CDC HHS/United States ; 5U58DP000824-04/DP/NCCDPHP CDC HHS/United States ; 5U62PS001005-05/PS/NCHHSTP CDC HHS/United States ; U62 PS004011/PS/NCHHSTP CDC HHS/United States ; 261201300021I/PHS HHS/United States ; U58 DP003875/DP/NCCDPHP CDC HHS/United States ; U62PS004001-2/PS/NCHHSTP CDC HHS/United States ; N01-PC-2013-00021/PC/NCI NIH HHS/United States ; 261201000024C/PHS HHS/United States ; 5U58/DP003931-02/DP/NCCDPHP CDC HHS/United States ; Z99 CA999999/Intramural NIH HHS/United States ; U58DP000848-04/DP/NCCDPHP CDC HHS/United States ; HHSN261201300021C/CA/NCI NIH HHS/United States ; U58 DP000848/DP/NCCDPHP CDC HHS/United States ; 5U58DP003921-03/DP/NCCDPHP CDC HHS/United States ; HHSN261201000024C/CA/NCI NIH HHS/United States ; U58 DP003921/DP/NCCDPHP CDC HHS/United States ; 5U58DP003875-01/DP/NCCDPHP CDC HHS/United States ; U62 PS001005/PS/NCHHSTP CDC HHS/United States ; U62 PS004001/PS/NCHHSTP CDC HHS/United States ; U62PS004011-02/PS/NCHHSTP CDC HHS/United States ; U58 DP000824/DP/NCCDPHP CDC HHS/United States
• Volume:
  30
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ccefdb39a5c2e1d154d334e562aa8ca566c7389cf35db21187b4505b9433a8a7
• Download URL:
  https://stacks.cdc.gov/view/cdc/39146/cdc_39146_DS1.pdf
• File Type:
  [PDF - 174.60 KB ]