High-risk human papilloma virus, precancerous lesions and cancer in anal condylomas

Abstract

Introduction: anal condylomas are associated with human papillomavirus (HPV) infection and are a risk factor for anal squamous cell carcinoma (SCC). Objective: to conduct a meta-analysis evaluating the prevalence of anal high-risk-HPV, high-grade squamous intraepithelial lesions (HSIL) and SCC in patients with condylomas. The standardised incidence ratio (SIR) and the incidence rate (IR) of anal SCC were also calculated. Methods: three electronic databases were searched until April 2020. Meta-analyses were performed using random effects models. Results: pooled prevalence estimate of HR-HPV in anal condylomas was 40.2% (21.0 − 63.1) in immunocompromised and 16.4% (10.7 − 24.3) in non-immunocompromised patients, with an odds ratio (OR) of 3.79 (1.51–9.52, P = 0.005) for immunocompromised patients. HR-HPV in condylomas with HSIL was 73.8% (39.1 − 92.5) and in non-HSIL cases was 17.7% (9.6 − 30.2), corresponding to an OR of 12.33 (2.97–51.21, P = 0.001) for those with HSIL. The prevalence of HSIL in condylomas was 24.0% (16.4 − 33.7) in immunocompromised and 11.8% (7.2 − 18.8) in non-immunocompromised patients, with an OR of 2.51 (1.72–3.65, P < 0.001) for immunocompromised patients. The overall prevalence of anal SCC was 0.3% (0.0 − 1.7). The SIR of anal SCC was 10.7 (8.5 − 13.5), 20.1 (14.4 − 28.2) in men and 7.7 (5.6 − 10.5) in women. The overall IR of anal SCC was 6.5 per 100 000 persons-year (3.6 − 11.7), 12.7 (9.1 − 17.8) in men and 4.7 (1.7 − 13) in women. Conclusion: patients with a history of anal condylomas have a high risk of anal SCC, especially men. The prevalence of HR-HPV and HSIL in condylomas from immunocompromised patients is high. This information can change patient follow-up and treatment.