QS211 - Longitudinal Evaluation of Anal Dysplasia: Recurrence Rates and Gaps in Surveillance

Monday, May 12, 2025

10:36 AM – 10:39 AM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

JC Chen, MD (they/them/theirs)

Resident
Ohio State University
Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

Evan D. Adams, MD (he/him/his)

Fellow
The Ohio State University
Columbus, OH, United States

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Kent J. Peterson, MD

Fellow
Ohio State University
Columbus, OH, United States

All of the relevant financial relationships listed below have been mitigated.
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Melik K. Aktas, MD (he/him/his)

Research Fellow
The Ohio State University
Columbus, OH, United States

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This individual has no financial relationships with ineligible companies.
AH

Alan E. Harzman, MD

Professor
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Emily Huang, MD

Assistant Professor
The Ohio State University
Columbus, Ohio, United States

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This individual has no financial relationships with ineligible companies.
Amber L. Traugott, MD (she/her/hers)

Associate Professor
The Ohio State University
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure information not submitted.
Lisa A. Cunningham, MD

Assistant Professor
The Ohio State University
Columbus, Ohio, United States

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Alessandra Gasior, DO

Associate Professor
The Ohio State University
Columbus, Ohio, United States

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Matthew F. Kalady, MD

Professor, Division Director,
The Ohio State University Wexner Medical Center and James Cancer Center
Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

Syed Husain, MD

Professor
The Ohio State University
Ohio State University
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

JC Chen, MD: This individual has no financial relationships with ineligible companies.

Evan D. Adams, MD: This individual has no financial relationships with ineligible companies.

Kent J. Peterson, MD: This individual has no financial relationships with ineligible companies.

Melik K. Aktas, MD: This individual has no financial relationships with ineligible companies.

Emily Huang, MD: This individual has no financial relationships with ineligible companies.

Lisa A. Cunningham, MD: This individual has no financial relationships with ineligible companies.

Alessandra Gasior, DO: This individual has no financial relationships with ineligible companies.

Syed Husain, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The landmark Anal Cancer-HSIL Outcomes Research (ANCHOR) trial highlighted the necessity of treating high-grade dysplasia (HGD) in people living with HIV to prevent progression to anal cancer. While a single treatment of HGD would theoretically eradicate the lesion, recurrence of human papillomavirus (HPV) lesions remains high. There is no consensus on optimal surveillance of anal dysplasia. However, existing protocols recommend downgrading the cadence and intensity of surveillance for patients presenting with LGD. In our clinical experience, we have observed progression from LGD and recurrence after ablation of HGD. This study provides a longitudinal evaluation of outcomes in patients with anal dysplasia who undergo repeated high-resolution anoscopy (HRA) followed by ablation to quantify our observations.

Methods/Interventions: Patients age 18+ who underwent HRA for abnormal anal cytology at the Ohio State University’s Comprehensive Cancer Center between 2017-2024 were retrospectively reviewed. LGD was defined as biopsy-proven anal intraepithelial neoplasia-1 (AIN-1). HGD was defined as AIN-2 or AIN-3. Kaplan-Meier/Nelson-Aalen estimates and Cox proportional hazards models evaluated time to progression from LGD to HGD and time to downstaging HGD to LGD-only, controlling for HIV status.

Results/Outcomes: A total of 517 patients underwent HRA exams, out of which 199 (38.5%) followed up in clinic after their index visit. Of these, 38 (19.1%) initially presented with LGD and 158 (79.4%) presented with HGD. Among patients who followed-up, a third of patients who presented with LGD during their index visit (index-LGD) returned with HGD in their subsequent visit, irrespective of HIV status (HIV- 45.5% vs HIV+ 54.5%, p=0.425, Figure 1). Over 2/3 of patients with index-LGD returned with HGD by their 3rd follow-up visit. However, only 36.8% of patients with index-LGD returned for a third follow-up visit. Additionally, among patients who followed-up, only 16% of patients who initially presented with HGD (index-HGD) were downstaged to LGD-only by their second follow-up visit. Rather, at least four follow-up visits were necessary for at least 50% of index-HGD patients to return with LGD-only, irrespective of HIV status (HIV- 40.9%, HIV+ 59.1%, p=0.740, Figure 2). Yet only 5.1% of patients with index-HGD had five or more follow-up visits. Median time interval between visits was 497 days (IQR 681.5 days) for index-LGD patients and 224 days (IQR 206 days) for index-HGD patients.

Conclusion/Discussion: While treatment of HGD is essential in preventing progression to anal cancer, repeated treatments and ongoing surveillance of patients with LGD appears to be equally critical due to the significant risk of progression to HGD within this cohort. Findings of the current study call for a necessary re-evaluation of prevailing surveillance protocols for LGD. Our study also underscores the suboptimal adherence to surveillance recommendations in this marginalized, at-risk population, highlighting the importance of patient engagement, education, and support.