Kapacee Z A, Susnerwala S, Wise M, Biswas A, Danwata F, Scott N
Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK.
Colorectal Dis. 2016 Nov;18(11):1080-1086. doi: 10.1111/codi.13342.
Previous literature has sought prognostic factors for the survival of anal cancer patients. The present study aimed to determine prognostic factors for local disease recurrence, distant metastasis and survival for patients treated with radical chemoradiotherapy (CRT) at the Rosemere Cancer Centre, Preston, UK.
Patients treated with CRT for nonmetastatic squamous cell anal cancer between September 2000 and January 2013 were studied. Kaplan-Meier and Cox regression analysis assessed the prognostic value of age, sex, tumour size, the proportion of the anal canal circumference involved (ACCI), nodal disease, tumour location and pretreatment haemoglobin.
One hundred and 48 patients with a mean age of 63 years were studied, of whom 15% suffered local disease recurrence and 10% developed distant metastasis. The 5-year overall and cancer-specific survival rates were 84% and 86%, respectively. Predictors of local recurrence were tumour size >5 cm and over two-thirds ACCI (P < 0.01). Predictors of distant metastasis and poor survival were tumour size >5 cm (P < 0.01), node positive disease on imaging (P < 0.05), over two-thirds ACCI (P < 0.01) and a pretreatment haemoglobin level below 130 g/l (P < 0.05). Multivariate analysis found large tumour size to be the most significant factor for local recurrence (P = 0.002) and survival (P = 0.02) whilst over two-thirds ACCI was most predictive of distant metastasis (P < 0.001). Age, gender, palpable lymph nodes and tumour location were not of prognostic value for local disease recurrence, distant metastasis or survival.
Tumour size, nodal disease, over two-thirds ACCI and low pretreatment haemoglobin confer poorer prognostic and survival outcomes. Use of intensity-modulated radiation therapy may allow greater radiation doses to be given for locally advanced tumours, thus improving local control and survival and reducing morbidity.
既往文献一直在探寻肛管癌患者生存的预后因素。本研究旨在确定在英国普雷斯顿罗斯梅尔癌症中心接受根治性放化疗（CRT）的患者局部疾病复发、远处转移及生存的预后因素。
对2000年9月至2013年1月期间接受CRT治疗的非转移性鳞状细胞肛管癌患者进行研究。采用Kaplan-Meier法和Cox回归分析评估年龄、性别、肿瘤大小、肛管周径受累比例（ACCI）、淋巴结疾病、肿瘤位置及治疗前血红蛋白水平的预后价值。
共研究了148例平均年龄为63岁的患者，其中15%出现局部疾病复发，10%发生远处转移。5年总生存率和癌症特异性生存率分别为84%和86%。局部复发的预测因素为肿瘤大小>5 cm及ACCI超过三分之二（P<0.01）。远处转移及生存不良的预测因素为肿瘤大小>5 cm（P<0.01）、影像学检查显示淋巴结阳性疾病（P<0.05）、ACCI超过三分之二（P<0.01）及治疗前血红蛋白水平低于130 g/l（P<0.05）。多因素分析发现，大肿瘤大小是局部复发（P=0.002）和生存（P=0.02）的最显著因素，而ACCI超过三分之二对远处转移的预测性最强（P<0.001）。年龄、性别、可触及淋巴结及肿瘤位置对局部疾病复发、远处转移或生存无预后价值。
肿瘤大小、淋巴结疾病、ACCI超过三分之二及治疗前血红蛋白水平低提示预后及生存结局较差。使用调强放射治疗可能使局部晚期肿瘤能够接受更高的放射剂量，从而改善局部控制和生存并降低发病率。
