Belkacémi Yazid, Berger Christine, Poortmans Philip, Piel Gaëlle, Zouhair Abderrahim, Méric Jean-Baptiste, Nguyen Tan-Dat, Krengli Marco, Behrensmeier Franck, Allal Abdelkarim, De Looze Dany, Bernier Jacques, Scandolaro Luciano, Mirimanoff René-Olivier
Radiation Therapy, Oscar Lambret Center, Lille, France
Int J Radiat Oncol Biol Phys. 2003 Aug 1;56(5):1274-83. doi: 10.1016/s0360-3016(03)00277-3.
Primary adenocarcinoma of the anus is a rare tumor. The current standard treatment consists of abdominoperineal resection (APR). The aim of this Rare Cancer Network study was to evaluate the prognostic factors and outcome after the three most commonly used treatment approaches.
This multicenter study collected data from 82 patients: 15 with T1 (18%), 34 with T2 (42%), 22 with T3 (27%), and 11 with T4 (13%) tumors according to the TNM classification (International Union Against Cancer, 1997). Patients were separated into, and analyzed according to, three treatment categories: radiotherapy/surgery (RT/S group, n = 45), combined radiochemotherapy (RT/CHT group, n = 31), and APR alone (APR group, n = 6). The main patient characteristics were evenly distributed among the three groups.
The actuarial locoregional relapse rate at 5 years was 37%, 36%, and 20%, respectively, in the RT/S, RT/CHT, and APR groups (RT/S vs. RT/CHT, p = 0.93; RT/CH vs. APR, p = 0.78). The 3-, 5-, and 10-year overall survival rate was 47%, 29%, and 23% in the RT/S group, 75%, 58%, and 39% in the RT/CHT group, and 42%, 21%, and 21% in the APR group (RT/CHT vs. RT/S, p = 0.027), respectively. The 5- and 10-year disease-free survival rate was 25% and 18% in the RT/S group, 54% and 20% in the RT/CHT group, and 22% and 22% in the APR group (RT/CHT vs. RT/S, p = 0.038), respectively. Multivariate analysis revealed four independent prognostic factors for survival: T stage, N stage, histologic grade, and treatment modality.
Primary adenocarcinoma of the anal canal requires rigorous management. Multivariate analysis showed that T and N stage, histologic grade, and treatment modality are independent prognostic factors for survival. We observed better survival rates after combined RT/CHT. We also recommend using APR only for salvage treatment.
原发性肛门腺癌是一种罕见肿瘤。目前的标准治疗方法是腹会阴联合切除术（APR）。这项罕见癌症网络研究的目的是评估三种最常用治疗方法后的预后因素和结果。
这项多中心研究收集了82例患者的数据：根据TNM分类（国际抗癌联盟，1997年），15例为T1期（18%），34例为T2期（42%），22例为T3期（27%），11例为T4期（13%）。患者被分为三个治疗类别并进行分析：放疗/手术（RT/S组，n = 45）、放化疗联合（RT/CHT组，n = 31）和单纯APR（APR组，n = 6）。主要患者特征在三组中分布均匀。
RT/S组、RT/CHT组和APR组5年精算局部区域复发率分别为37%、36%和20%（RT/S组与RT/CHT组比较，p = 0.93；RT/CH组与APR组比较，p = 0.78）。RT/S组3年、5年和10年总生存率分别为47%、29%和23%，RT/CHT组分别为75%、58%和39%，APR组分别为42%、21%和21%（RT/CHT组与RT/S组比较，p = 0.027）。RT/S组5年和10年无病生存率分别为25%和18%，RT/CHT组分别为54%和20%，APR组分别为22%和22%（RT/CHT组与RT/S组比较，p = 0.038）。多因素分析显示生存的四个独立预后因素：T分期、N分期、组织学分级和治疗方式。
原发性肛管腺癌需要严格管理。多因素分析表明，T和N分期、组织学分级和治疗方式是生存的独立预后因素。我们观察到放化疗联合后生存率更高。我们还建议仅将APR用于挽救治疗。
