Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pennsylvania.
Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania.
Cancer Med. 2019 Jul;8(8):3855-3863. doi: 10.1002/cam4.2076. Epub 2019 Jun 7.
Primary Adenocarcinoma of the anus is a rare disease with a poor prognosis and thus tends to have a more aggressive treatment algorithm, typically involving a surgical approach. Prior to 2001, a few retrospective studies outlined improved outcomes with the incorporation of surgery with chemoradiation. However, since the publication of these studies, advancement in radiotherapy modalities and imaging have left the question of improved outcomes while reserving surgery for salvage.
We conducted this National Cancer Database (NCDB)-driven retrospective study to analyze treatment trends and outcomes in the current time from 2004 to 2015 with respect to chemoradiation and surgery.
Retrospective NCDB tumor registry data review-using propensity score-adjusted multivariable analyses for survival.
Database review.
We selected for patients listed in the NCDB with AJCC stage 1-3 anal adenocarcinoma diagnosed between 2004 and 2015 and selected out patients with undocumented/stage 4 disease, those with radiation outside the pelvis, not treated with systemic therapy and patients lost to follow-up.
EXPOSURE(S): None.
Overall survival and use of surgery in the up-front management of anal adenocarcinoma.
Of the 1729 patients eligible in this study, 1028 were treated with surgery as up-front management and 701 had definitive chemoradiation. Median overall survival for all patients was 55 months with a 5-year survival rate of 55%. Patients treated without surgery had worse overall survival, median survival of 45 months compared to 87 months (P < 0.0001) with 5-year survival rates of 42% and 55% in favor of incorporation of surgery. Analysis across patients treated with surgery alone, surgery followed by adjuvant chemoradiation, neoadjuvant chemoradiation followed by surgery, and chemoradiation alone had median survival rates of 78, 83, 92, and 46 months, respectively. Propensity score-adjusted multivariable analysis identified older age, grade 3, high comorbidity score, and lack of surgery as predictive of worse outcome.
The results of the NCDB analysis indicate improved overall survival with the incorporation of surgery into the initial management of anal adenocarcinoma when compared to chemoradiation alone, despite the omission of surgery in up to 50% of the cases logged. Our results corroborate earlier studies published prior to the year 2000 for surgery to be included in the definitive management of anal adenocarcinoma.
原发性肛门腺癌是一种罕见疾病，预后较差，因此倾向于采用更具侵袭性的治疗方案，通常包括手术方法。在 2001 年之前，少数回顾性研究概述了将手术与放化疗结合使用可改善预后。然而，自这些研究发表以来，放射治疗方式和影像学的进步使得在保留手术作为挽救手段的同时，提高手术效果的问题悬而未决。
我们进行了这项基于国家癌症数据库（NCDB）的回顾性研究，以分析 2004 年至 2015 年期间，与放化疗和手术相关的当前治疗趋势和结果。
NCDB 肿瘤登记数据回顾-使用倾向评分调整的多变量分析进行生存分析。
数据库回顾。
我们选择了 NCDB 中列出的 AJCC 分期为 1-3 期肛门腺癌患者，诊断时间为 2004 年至 2015 年，并排除了未记录/分期为 4 期的患者、接受骨盆外放疗的患者、未接受系统治疗的患者以及失访的患者。
无。
肛门腺癌初始治疗中手术的总体生存率和应用。
在这项研究中，符合条件的 1729 名患者中，1028 名接受了手术作为初始治疗，701 名接受了确定性放化疗。所有患者的中位总生存期为 55 个月，5 年生存率为 55%。未接受手术治疗的患者总体生存率较差，中位生存期为 45 个月，而接受手术治疗的患者中位生存期为 87 个月（P<0.0001），5 年生存率分别为 42%和 55%，表明手术的纳入有获益。对仅接受手术治疗、手术后继以辅助放化疗、新辅助放化疗后继以手术治疗以及单纯放化疗治疗的患者进行分析，中位生存期分别为 78、83、92 和 46 个月。倾向评分调整的多变量分析表明，年龄较大、3 级、高合并症评分和未手术是预后较差的预测因素。
NCDB 分析的结果表明，与单纯放化疗相比，将手术纳入肛门腺癌的初始治疗可提高总体生存率，尽管在记录的病例中多达 50%的病例未行手术。我们的结果证实了 2000 年之前发表的早期研究，即手术应纳入肛门腺癌的确定性治疗。
