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

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 standardized incidence ratio (SIR) and the incidence rate 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 high-risk HPV (HR-HPV) in anal condylomas was 40.2% (21.0–63.1) in immunocompromised and 16.4% (10.7–24.3) in nonimmunocompromised 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 nonimmunocompromised patients, with an OR of 2.51 (1.72–3.65, P < 0.001) for immunocompromised patients. The overall prevalence of anal SCC in anal condylomas 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 incidence rate of anal SCC was 6.5 per 100 000 person-years (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.