ATLANTA — High-grade anogenital intraepithelial neoplasia has remarkably high recurrence and malignancy potential despite repeated treatments; thus long-term surveillance is mandatory, according to Dr. Mathias K. Fehr of University Hospital, Zurich, Switzerland.
A retrospective study of 442 patients with biopsy-proven grade 2–3 intraepithelial neoplasia of the vulva (VIN), vagina (VAIN), or perianal skin (PAIN) showed that progression to invasive disease occurred in 4% of the 433 treated patients within a mean of 8 years, Dr. Fehr reported in a poster at the annual meeting of the American Society of Clinical Oncology.
Recurrent disease, defined as VIN, VAIN, or PAIN diagnosed at least 1 year after the initial diagnosis, occurred in 32% of the treated patients, and among treated patients with a follow-up of longer than 5 years, 14% continued to experience recurrences. On multivariate analysis, immunosuppression was shown to be associated with recurrence (odds ratio 2.33), and immunosuppression and smoking were shown to be independent risk factors for disease progression (odds ratios 3.31 and 3.12, respectively).
Patients had a mean age of 47 years at initial diagnosis, and were treated with biopsy and laser evaporation in 62% of cases, surgical excision in 33% of cases, and other local destructive methods in 3% of cases. Nine patients (2%) refused treatment, Dr. Fehr noted.
Particular attention should be paid to long-term surveillance of VIN, VAIN, and PAIN in immunosuppressed patients and in patients who smoke, he concluded.