Department of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
Clin Colorectal Cancer. 2020 Sep;19(3):e75-e82. doi: 10.1016/j.clcc.2020.04.001. Epub 2020 Apr 13.
Anal adenocarcinoma (AA) is reported to represent 5% to 10% of all anal cancer. Currently there is no evidence-based treatment of AA. We investigated clinical outcomes after treatment regimens in patients with AA and used the Surveillance, Epidemiology, and End Results (SEER) registry to examine the outcome.
We searched for patients diagnosed with histologically confirmed adenocarcinoma of the anal canal with stage I to III disease between 2010 and 2016 using SEER∗Stat software.
A total of 393 patients treated from 2010 to 2016 for AA were identified. Patients were divided into 5 groups according to treatment: 68 patients (17.3%) receiving radiotherapy (RT) and chemotherapy (CTx), 16 patients (4.1%) receiving RT or CTx, 108 patients (27.5%) receiving surgery alone, 137 patients (34.8%) receiving preoperative RT or CTx with surgery, and 64 patients (16.3%) receiving postoperative RT or CTx with surgery. The 3-year cause-specific survival (CSS) rates were 63.9% in the RT and CTx group, 35.7% in the RT or CTx group, 77.7% in the surgery-alone group, 80.3% in the preoperative RT or CTx group, and 65.8% in the postoperative group (P < .001). Preoperative RT or CTx was associated with improved CSS on multivariate analysis (P = .024). The 3-year CSS rates for those who received surgery and those who did not receive surgery were 81.5% and 87.5% for stage I disease, and 74.4% and 57.3% for stage II/III disease.
Preoperative treatment with surgical resection may maximize the survival outcome. Although chemoradiotherapy alone may be sufficient for early stages of disease, patients with advanced disease should be treated with a combination of surgical resection and chemoradiotherapy. Future studies are required to determine the appropriate treatment strategies in AA.
据报道，肛门腺癌（AA）占所有肛门癌的 5%至 10%。目前，AA 尚无循证治疗方法。我们研究了 AA 患者接受不同治疗方案后的临床结果，并利用监测、流行病学和最终结果（SEER）数据库来检查结果。
我们使用 SEER∗Stat 软件搜索了 2010 年至 2016 年间经组织学证实为肛管腺癌且处于 I 期至 III 期的患者。
共确定了 393 例 2010 年至 2016 年期间接受 AA 治疗的患者。根据治疗方法将患者分为 5 组：68 例（17.3%）接受放化疗（RT+CTx），16 例（4.1%）接受 RT 或 CTx，108 例（27.5%）接受单纯手术，137 例（34.8%）接受术前 RT+CTx+手术，64 例（16.3%）接受术后 RT+CTx+手术。RT+CTx 组、RT 或 CTx 组、单纯手术组、术前 RT+CTx 组和术后 RT+CTx 组的 3 年特异性生存（CSS）率分别为 63.9%、35.7%、77.7%、80.3%和 65.8%（P<.001）。多因素分析显示，术前 RT+CTx 与 CSS 改善相关（P=.024）。I 期疾病接受手术和未接受手术患者的 3 年 CSS 率分别为 81.5%和 87.5%，II/III 期疾病的 3 年 CSS 率分别为 74.4%和 57.3%。
手术切除前进行治疗可能最大限度地提高生存结果。虽然单纯放化疗可能足以治疗早期疾病，但晚期疾病患者应接受手术切除联合放化疗。需要进一步研究确定 AA 的适当治疗策略。
