HPV感染相关肛门癌的预防与筛查：现状、挑战与未来

doi:10.16139/j.1007-9610.2026.02.02

摘要/Abstract

摘要：

肛门癌是一种与人乳头瘤病毒（HPV）感染密切相关的恶性肿瘤，其发病率在全球范围内呈上升趋势。高危型HPV的持续感染是肛门癌发生的核心驱动因素。目前，针对HPV感染相关肛门癌的防控策略主要围绕一级预防（接种HPV疫苗）与二级预防（高危人群筛查）展开。基于现有循证证据，HPV疫苗接种作为一级预防的核心手段，通过阻断高危型HPV持续感染，已展现出降低癌前病变肛门上皮内瘤变（AIN）发生率的明确效果。在二级预防领域，国内外指南已形成明确共识，建议对人类免疫缺陷病毒(HIV)感染者、男男性行为者（MSM）等高风险人群实施基于肛门细胞学、高危HPV检测及肛门镜检查的规范化筛查，早期发现与干预。

关键词: 人乳头瘤病毒疫苗, 肛门癌, 一级预防, 筛查

Abstract:

Anal cancer is a malignancy closely associated with human papillomavirus (HPV) infection, with a rising incidence globally. Persistent infection with high-risk HPV acted as the core driver of anal tumorigenesis. Currently, strategies for the prevention and control of HPV-related anal cancer primarily revolve around primary prevention (HPV vaccination) and secondary prevention (screening of high-risk populations). Based on existing evidence, HPV vaccination served as the core of primary prevention and demonstrated clear efficacy in reducing the incidence of anal intraepithelial neoplasia (AIN) by blocking persistent high-risk HPV infection. Regarding secondary prevention, domestic and international guidelines have reached a consensus recommending standardized screening based on anal cytology, high-risk HPV testing, and anoscopy for high-risk groups, such as people living with human immunodeficiency virus(HIV) and men who have sex with men (MSM), to facilitate early detection and intervention.

Key words: Human papillomavirus (HPV) vaccination, Anal cancer, Primary prevention, Screening

中图分类号:

R735.38

沈洁, 居星语, 郑莹. HPV感染相关肛门癌的预防与筛查：现状、挑战与未来[J]. 外科理论与实践, 2026, 31(02): 100-107.

SHEN Jie, JU Xingyu, ZHENG Ying. Prevention and screening of HPV-associated anal cancer: current status, challenges, and future perspectives[J]. Journal of Surgery Concepts & Practice, 2026, 31(02): 100-107.

参考文献 32

[1]	BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	DE MARTEL C, GEORGES D, BRAY F, et al. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis[J]. Lancet Glob Health, 2020, 8(2):e180-e190. doi: 10.1016/S2214-109X(19)30488-7 pmid: 31862245
[3]	Surveillance Research Program, National Cancer Institute. SEER*Explorer: an interactive website for SEER cancer statistics[EB/OL]. [2026-01-15]. https://seer.cancer.gov/statfacts/html/anus.html.
[4]	International Agency For Rearch Cancer. GLOBOCAN 2022[EB/OL]. [2026-01-15]. https://gco.iarc.who.int/media/globocan/factsheets/cancers/10-anus-fact-sheet.pdf.
[5]	DESHMUKH A A, DAMGACIOGLU H, GEORGES D, et al. Human papillomavirus-associated anal cancer incidence and burden among US men, according to sexual orientation, human immunodeficiency virus status, and age[J]. Clin Infect Dis, 2023, 77(3):419-424. doi: 10.1093/cid/ciad205 URL
[6]	WOLF J, KIST L F, PEREIRA S B, et al. Human papillomavirus infection: epidemiology, biology, host interactions, cancer development, prevention, and therapeutics[J]. Rev Med Virol, 2024, 34(3):e2537. doi: 10.1002/rmv.2537 pmid: 38666757
[7]	IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Human papillomaviruses[J]. IARC Monogr Eval Carcinog Risks Hum, 2007,90:1-636.
[8]	DE MARTEL C, PLUMMER M, VIGNAT J, et al. Worldwide burden of cancer attributable to HPV by site, country and HPV type[J]. Int J Cancer, 2017, 141(4):664-670. doi: 10.1002/ijc.30716 pmid: 28369882
[9]	元玫雯, 王宏昊, 段如菲, 等. 2016年中国归因于人乳头瘤病毒感染的肿瘤发病与死亡分析[J]. 中华流行病学杂志, 2022, 43(5):702-708.
	YUAN M W, WANG H H, DUAN R F, et al. Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016[J]. Chin J Epidemiol, 2022, 43(5):702-708.
[10]	DESHMUKH A A, DAMGACIOGLU H, GEORGES D, et al. Global burden of HPV-attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: a worldwide analysis[J]. Int J Cancer, 2023, 152(3):417-428. doi: 10.1002/ijc.v152.3 URL
[11]	MCBRIDE A A. Human malignancies associated with persistent HPV infection[J]. Oncologist, 2024, 29(6):457-464. doi: 10.1093/oncolo/oyae071 pmid: 38630576
[12]	ZANDBERG D P, BHARGAVA R, BADIN S, et al. The role of human papillomavirus in nongenital cancers[J]. CA Cancer J Clin, 2013, 63(1):57-81.
[13]	PALEFSKY J M, GIULIANO A R, GOLDSTONE S, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia[J]. N Engl J Med, 2011, 365(17):1576-1585. doi: 10.1056/NEJMoa1010971 URL
[14]	GOLDSTONE S E, GIULIANO A R, PALEFSKY J M, et al. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial[J]. Lancet Infect Dis, 2022, 22(3):413-425. doi: 10.1016/S1473-3099(21)00327-3 URL
[15]	GIULIANO A R, PALEFSKY J M, GOLDSTONE S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males[J]. N Engl J Med, 2011, 364(5):401-411. doi: 10.1056/NEJMoa0909537 URL
[16]	PALEFSKY J M, LENSING S Y, BELZER M, et al. High prevalence of anal high-grade squamous intraepithelial lesions, and prevention through human papillomavirus vaccination, in young men who have sex with men living with human immunodeficiency virus[J]. Clin Infect Dis, 2021, 73(8):1388-1396. doi: 10.1093/cid/ciab434 URL
[17]	HIDALGO-TENORIO C, PASQUAU J, OMAR-MOHAMED M, et al. Effectiveness of the quadrivalent HPV vaccine in preventing anal≥HSILs in a Spanish population of HIV+MSM aged>26 years[J]. Viruses, 2021, 13(2):144. doi: 10.3390/v13020144 URL
[18]	KREIMER A R, GONZÁLEZ P, KATKI H A, et al. Efficacy of a bivalent HPV 16/18 vaccine against anal HPV 16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial[J]. Lancet Oncol, 2011, 12(9):862-870. doi: 10.1016/S1470-2045(11)70213-3 pmid: 21865087
[19]	WHO. WHO position papers on human papillomavirus (HPV)[EB/OL]. (2022-12-16)[2025-12-30]. https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/human-papillomavirus-(hpv).
[20]	OSHMAN L D, DAVIS A M. Human papillomavirus vaccination for adults: updated recommendations of the advisory committee on immunization practices (ACIP)[J]. JAMA, 2020, 323(5):468-469. doi: 10.1001/jama.2019.18411 pmid: 31930397
[21]	MEITES E, SZILAGYI P G, CHESSON H W, et al. Human papillomavirus vaccination for adults: updated recommendations of the advisory committee on immunization practices[J]. Morb Mortal Wkly Rep, 2019, 68(32):698-702.
[22]	中华医学会妇科肿瘤学分会, 中国优生科学协会阴道镜和宫颈病理学分会. 人乳头瘤病毒疫苗临床应用中国专家共识[J]. 中国妇产科临床杂志, 2021, 22(2):225-234.
	Chinese Society of Gynecologic Oncology, Chinese Medical Association, Chinese Society for Colposcopy and Cervical Pathology of China Healthy Birth Science Association. Chinese expert consensus on clinical application of human papillomavirus vaccine[J]. Chin J Clin Obstet Gynecol, 2021, 22(2):225-234.
[23]	中国抗癌协会, 中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-肛管癌(2024 版)[J]. 中华结直肠疾病电子杂志, 2024, 13(6):441-449.
	China Anti-Cancer AssociationColorectal Cancer Professional Committee, Chinese Anti-Cancer Association. CACA guidelines for holistic integrative management of anal cancer(2024 Edition)[J]. Chin J Colorec Dis, 2024, 13(6):441-449.
[24]	中华预防医学会肿瘤预防与控制专业委员会, 中华预防医学会疫苗与免疫分会. 人乳头瘤病毒相关的非宫颈疾病早期预防专家共识(2025版)[J]. 中华医学杂志, 2025, 105(30):2536-2550.
	Cancer Prevention and Control Committee, Chinese Preventive Medicine Association Vaccine and Immunization Branch, Chinese Preventive Medicine Association. Expert consensus on the early prevention of human papillomavirus related non-cervical diseases (2025 edition)[J]. Natl Med J China, 2025, 105(30):2536-2550.
[25]	中国优生科学协会阴道镜和宫颈病理学分会, 中华医学会妇科肿瘤学分会, 中国妇幼健康研究会子宫颈癌防控研究专业委员会, 等. 肛门上皮内瘤变诊治中国专家共识[J]. 肿瘤综合治疗电子杂志, 2023, 9(3):49-56.
	Chinese Society for Colposcopy and Cervical Pathology of China Healthy Birth Science Association; Chinese Socie-ty of Gynecologic Oncology, Chinese Medical Association; Chinese Association for Maternal and Child Health Studies, Branch of Cancer Prevention and Control, Chinese Preventive Medicine Association, et al. Chinese expert consensus on diagnosis and treatment of anal intraepithelial neoplasia[J]. J Multidiscip Cancer Manag, 2023, 9(3):49-56.
[26]	WHO. HPV vaccine inclued in national immunization programme[EB/OL]. (2025-12-19)[2025-12-30]. https://app.powerbi.com/view?r=eyJrIjoiNDIxZTFkZGUtMDQ1Ny00MDZkLThiZDktYWFlYTdkOGU2NDcwIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5M-CIsImMiOjh9.
[27]	NCCN. NCCN clinical practice guidelines in oncology:anal carcinoma (version 4.20254)[EB/OL]. (2025-05-30)[2025-12-30]. https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf.
[28]	STIER E A, CLARKE M A, DESHMUKH A A, et al. International anal neoplasia society's consensus guidelines for anal cancer screening[J]. Int J Cancer, 2024, 154(10):1694-1702. doi: 10.1002/ijc.34850 pmid: 38297406
[29]	HOLLIDAY E B, PEDDIREDDY A, MORRIS V K. Prognostic and predictive markers for patients with anal cancer[J]. J Natl Compr Canc Netw, 2023, 21(6):678-684. doi: 10.6004/jnccn.2023.7031 URL
[30]	FERRÉ V M, DUPONT A, DRAULLETTE M, et al. Higher levels of host-cell DNA methylation markers ZNF582 and ASCL1 on anal smears are predictive for progression to anal cancer in patients with previous high-grade lesions[J]. EBioMedicine, 2025,120:105936.
[31]	VAN DER ZEE R P, RICHEL O, VAN NOESEL C J M, et al. Cancer risk stratification of anal intraepithelial neoplasia in human immunodeficiency virus-positive men by validated methylation markers associated with progression to cancer[J]. Clin Infect Dis, 2021, 72(12):2154-2163. doi: 10.1093/cid/ciaa397 pmid: 32266940
[32]	VASAVADA A, STANKIEWICZ KARITA H C, LIN J, et al. Methylation markers for anal cancer screening: a repeated cross-sectional analysis of people living with HIV, 2015-2016[J]. Int J Cancer, 2024, 155(6):1091-1100. doi: 10.1002/ijc.34977 pmid: 38680109