Karandikar S S, Borley A, Crosby T, Williams G, Reynolds S, Radcliffe A G
Princess of Wales Hospital, Bridgend, UK.
Colorectal Dis. 2006 May;8(4):266-72. doi: 10.1111/j.1463-1318.2005.00931.x.
A retrospective audit has been undertaken of Squamous (epidermoid) type of anal cancer diagnosed and treated in the principality of Wales over a five-year period (1995-99) with follow-up until 2005. The referral pattern, distribution, presenting symptoms, predisposing conditions, clinical findings and staging modalities were documented. The surgical and oncological treatment together with their outcome was analysed.
Patients were identified from the Welsh Cancer Registry and the pathology databases of the 17 acute hospitals in Wales. Data was collected from the clinical and oncology case notes onto a purpose designed Microsoft access database.
There was a wide variation in data quality from the individual units. Twenty-six anal cancers were diagnosed per year in the region. Median age was 69 years. Ten percent had documented perianal Human Papilloma Virus related disease. Radiology was inconsistently used for staging. Eighty percent were referred for an oncology opinion; 50% had chemo-radiotherapy with a curative intent. The over-all Stoma rate was 35% and of these 18% had an abdomino perineal resection. The overall five-year survival was 45%.
This is a unique regional audit of anal cancer. Improvements need to be made in documentation particularly of staging, treatment, pathology reporting and outcome. This study concurs that Human Papilloma Virus appears to predispose to Squamous anal cancer. Radiological staging needs to be standardized according to best clinical practice. As recommended by NICE all patients should be referred to a multidisciplinary anal cancer team, which can provide individual treatment plans. Increased specialization could mean specialist regional MDTs for anal cancer.
对威尔士公国在五年期间（1995 - 1999年）诊断和治疗的鳞状（表皮样）肛管癌进行回顾性审计，并随访至2005年。记录转诊模式、分布情况、症状表现、易感因素、临床检查结果和分期方式。分析手术和肿瘤治疗及其结果。
从威尔士癌症登记处和威尔士17家急症医院的病理数据库中识别患者。将临床和肿瘤病例记录中的数据收集到专门设计的微软Access数据库中。
各单位的数据质量差异很大。该地区每年诊断出26例肛管癌。中位年龄为69岁。10%的患者有记录显示患有肛周人乳头瘤病毒相关疾病。放射学在分期中的使用不一致。80%的患者被转诊以获得肿瘤学意见；50%的患者接受了根治性化疗放疗。总体造口率为35%，其中18%接受了腹会阴切除术。总体五年生存率为45%。
这是一项对肛管癌的独特区域审计。在记录方面，尤其是分期、治疗、病理报告和结果记录方面需要改进。本研究一致认为人乳头瘤病毒似乎易引发鳞状肛管癌。放射学分期需要根据最佳临床实践进行标准化。正如英国国家卫生与临床优化研究所所建议的，所有患者都应转诊至多学科肛管癌团队，该团队可以提供个体化治疗方案。增加专业化可能意味着设立专门的区域肛管癌多学科诊疗团队。
