Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
Department of Radiation Oncology, Cancer Center and Research Institute, Weil Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA.
Ann Surg Oncol. 2019 May;26(5):1351-1357. doi: 10.1245/s10434-019-07202-4. Epub 2019 Feb 4.
Anal adenocarcinoma (AA) is a rare histologic subtype of anal cancer believed to have worse outcomes than anal squamous cell carcinoma (AS). This study aimed to examine practice patterns and treatment outcomes for this rare subtype using the National Cancer Data Base (NCDB).
Patients who had new diagnoses of anal cancer treated with chemoradiation were selected from the NCDB from 2004 to 2015. The patients were divided into two histologic groups (AA or AS). Statistics included the Chi square test to analyze categorical proportions in demographic information, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS.
The study analyzed 24,461 patients. Compared with AS patients, AA patients were more likely to be male, to present with a higher cancer stage, to be older (> 65 years), and to undergo surgery with an abdominoperineal resection (APR). The median OS was 72.5 months for the AA patients and 143.8 months for the AS patients (P < 0.001). Survival was longer for the AA patients undergoing APR within 6 months after chemoradiation (CRT) than for the AA patients who had an APR 6 months after CRT (88.3 vs. 58.1 months; P < 0.001). In the multivariable analysis, the factors associated with worse survival included adenocarcinoma subtype, age of 55 years or older, male gender, T stage of 3 or higher, comorbidity score of 1 or higher, lower income, and treatment at a nonacademic institution.
In this largest study of anal adenocarcinoma to date, trimodality therapy was associated with better survival than chemoradiation alone.
肛门腺癌（AA）是一种罕见的肛门癌组织学亚型，据信其预后比肛门鳞状细胞癌（AS）差。本研究旨在利用国家癌症数据库（NCDB）检查这种罕见亚型的治疗模式和治疗结果。
从 2004 年至 2015 年，从 NCDB 中选择接受放化疗治疗的新发肛门癌患者。将患者分为两组（AA 或 AS）。统计学方法包括卡方检验分析人口统计学信息中的分类比例、Kaplan-Meier 分析评估总生存期（OS）和 Cox 比例风险模型确定与 OS 相关的变量。
本研究共分析了 24461 例患者。与 AS 患者相比，AA 患者更可能是男性，癌症分期更高，年龄更大（>65 岁），并接受经腹会阴联合切除术（APR）手术。AA 患者的中位 OS 为 72.5 个月，AS 患者的中位 OS 为 143.8 个月（P<0.001）。接受放化疗后 6 个月内接受 APR 的 AA 患者的生存时间长于放化疗后 6 个月接受 APR 的 AA 患者（88.3 个月比 58.1 个月；P<0.001）。多变量分析表明，与较差生存相关的因素包括腺癌亚型、55 岁或以上、男性、T 分期 3 期或更高、合并症评分 1 分或更高、收入较低和在非学术机构治疗。
在迄今为止最大的肛门腺癌研究中，三联疗法与单纯放化疗相比可提高生存率。
