Brown D K, Oglesby A B, Scott D H, Dayton M T
Department of Surgery, University of Iowa, Hospitals and Clinics, Iowa City.
Am Surg. 1988 Jun;54(6):337-42.
Squamous cell carcinoma of the anus (SCCA), an aggressive and often fatal malignancy, has traditionally been treated with surgery. In recent years, however, nonoperative therapy has emerged as an alternative to operation. Twenty five years of experience with SCCA at this institution were reviewed to examine the presentation and outcome of a population treated primarily with surgery. Forty two patients, including 26 women and 16 men, had a mean age of 56 years. SCCA was usually heralded by a mass, bleeding, or pain and was associated with chronic perianal disease in 25.8%. Symptoms were present for an average of 11 months. Among the patients in this review, 92.3 per cent underwent radical surgery, while 11.9 per cent had radiation as their primary therapy following palliative surgery or local excisions for biopsy. Actuarial 5-year-survival for the entire group was 45.5 percent; all patients with nodal or disseminated disease at diagnosis have died. Patients with perianal lesions fared no better than those with anal tumors, probably due to the unusually large perianal tumors in this series. To diagnose SCCA at its earliest stage, a high index of suspicion must be maintained when dealing with anal and perianal lesions, especially if the abnormality is chronic. When compared with reported advances in combined therapy, it is likely that in most cases surgery alone no longer offers optimal treatment for SCCA.
肛门鳞状细胞癌（SCCA）是一种侵袭性强且往往致命的恶性肿瘤，传统上采用手术治疗。然而，近年来，非手术治疗已成为手术的替代方案。回顾了本机构25年来对SCCA的治疗经验，以研究主要接受手术治疗的患者群体的临床表现和治疗结果。42例患者，包括26名女性和16名男性，平均年龄为56岁。SCCA通常以肿块、出血或疼痛为首发症状，25.8%的患者伴有慢性肛周疾病。症状平均持续11个月。在本次回顾的患者中，92.3%接受了根治性手术，而11.9%在姑息性手术或局部切除活检后以放疗作为主要治疗方法。整个组的5年精算生存率为45.5%；所有诊断时伴有淋巴结转移或播散性疾病的患者均已死亡。肛周病变患者的预后并不比肛门肿瘤患者好，这可能是由于该系列中肛周肿瘤异常大所致。为了尽早诊断SCCA，在处理肛门和肛周病变时，尤其是异常为慢性病变时，必须保持高度的怀疑指数。与联合治疗的报道进展相比，在大多数情况下，单纯手术可能不再是SCCA的最佳治疗方法。
