{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:32:13Z","timestamp":1784604733797,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007924","name":"University of Louisville","doi-asserted-by":"publisher","award":["Transdisciplinary\/Multidisciplinary Collaboration"],"award-info":[{"award-number":["Transdisciplinary\/Multidisciplinary Collaboration"]}],"id":[{"id":"10.13039\/100007924","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anal squamous cell cancer (ASCC) incidence in Kentucky is increasing at an alarming rate. In 2009, the incidence surpassed the US national average (2.66 vs. 1.77\/100,000 people), and currently, Kentucky ranks second by state per capita. The reasons for this rise are unclear. We hypothesize individuals with ASCC in Kentucky have some unique risk factors associated with worse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals with ASCC in a population\u2010level state database (1995\u20132016), as well as those treated at two urban university\u2010affiliated tertiary care centers (2011\u20132018), were included and analyzed separately. We evaluated patient\u2010level factors including demographics, tobacco use, stage of disease, HIV\u2010status, and HPV\u2010type. We evaluated factors associated with treatment and survival using univariable and multivariable survival analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 1698 individuals in state data and 101 in urban center data. In the urban cohort, 77% of patients were ever\u2010smokers. Eighty\u2010four percent of patients had positive HPV testing, and 58% were positive for HPV 16. Seventy\u2010two percent of patients were positive for p16. Neither smoking, HPV, nor p16 status were associated with disease persistence, recurrence\u2010free survival, or overall survival (all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Poorly controlled HIV (CD4 count &lt;500) at time of ASCC diagnosis was associated disease persistence (<jats:italic>p<\/jats:italic>\u2009=\u20090.032). Stage III disease (adjusted HR\u2009=\u20095.25, <jats:italic>p<\/jats:italic>\u2009=\u20090.025) and local excision (relative to chemoradiation; aHR\u2009=\u20090.19, <jats:italic>p<\/jats:italic>\u2009=\u20090.017) were significantly associated with reduced recurrence\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The rate of ASCC in Kentucky has doubled over the last 10\u2009years, which is outpacing anal SCC rates in the US with the most dramatic rates seen in Kentucky women. The underlying reasons for this are unclear and require further study. There may be other risk factors unique to Kentucky.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5865","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T04:49:37Z","timestamp":1680151777000},"page":"11462-11474","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Temporal increase in the incidence of anal squamous cell carcinoma in Kentucky and factors associated with adverse outcomes"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2686-0300","authenticated-orcid":false,"given":"Stephen J.","family":"O'brien","sequence":"first","affiliation":[{"name":"Price Institute of Surgical Research and Division of Colorectal Surgery, Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy T.","family":"Gaskins","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health &amp; Information Sciences University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0726-8830","authenticated-orcid":false,"given":"C. Tyler","family":"Ellis","sequence":"additional","affiliation":[{"name":"Price Institute of Surgical Research and Division of Colorectal Surgery, Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brock A.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health &amp; Information Sciences University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4463-0579","authenticated-orcid":false,"given":"Jaclyn","family":"Mcdowell","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Louisville  Louisville Kentucky USA"},{"name":"Markey Cancer Control Program, Kentucky Cancer Registry  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibson Dibe","family":"Gondim","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health &amp; Information Sciences University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9994-5263","authenticated-orcid":false,"given":"Susan","family":"Galandiuk","sequence":"additional","affiliation":[{"name":"Price Institute of Surgical Research and Division of Colorectal Surgery, Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-15-0044"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz219"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.45.2524"},{"key":"e_1_2_10_5_1","unstructured":"Age\u2010Adjusted Invasive Cancer Incidence Rates in the United States.Anus Anal Canal and Anorectum 2014\u20132018. Data released August 2021. Cancer\u2010Rates.info. Accessed on Jan 13 2022. CINA+ Online Cancer in North America.http:\/\/cancer\u2010rates.info\/naaccr\/"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.50.8.625"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002218"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2016.07.001"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_237433"},{"key":"e_1_2_10_10_1","unstructured":"DurbinE TuckerT RossF HandsI GregoryJ.Kentucky cancer registry. Markey cancer center University of Kentucky KY.2020. Accessed June 3 2020.https:\/\/www.kcr.uky.edu\/"},{"key":"e_1_2_10_11_1","unstructured":"Data reports.Data Reports\u2013Appalachian Regional Commission. Accessed March 7 2023.https:\/\/data.arc.gov\/data"},{"key":"e_1_2_10_12_1","first-page":"128","article-title":"Comparing human papillomavirus prevalence in rectal and anal cancer using US cancer registries, 2014\u20102015","volume":"46","author":"Mix J","year":"2019","journal-title":"J Registry Manag"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-1259"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-198212000-00014"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/81.3.515"},{"key":"e_1_2_10_18_1","unstructured":"QuickFacts Jefferson County.Kentucky; Kentucky.2021https:\/\/www.census.gov\/. 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