Maccabe Tom A, Parwaiz Iram, Longman Robert J, Thomas Michael G, Messenger David E
Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Colorectal Dis. 2021 Mar;23(3):689-697. doi: 10.1111/codi.15424. Epub 2020 Nov 30.
There is a paucity of data on outcomes from local excision (LE) of early anal squamous cell carcinomas (ASCCs). This study aimed to assess survival outcomes according to tumour location, perianal (PAT) or anal canal (ACT), and to determine factors associated with R1 excision and outcomes according to T-category.
This was a retrospective cohort study of consecutive patients with early ASCC treated by LE from 2007 to 2019. Data were collected on baseline demographics, tumour location, staging, excision histology, adjuvant treatment, site and timing of recurrence. The main outcome measures were R1 resection, locoregional recurrence (LRR), disease-free survival and overall survival.
Of 367 patients treated for ASCC, 39 (10.6%) patients with complete follow-up data underwent LE: 15 ACTs and 24 PATs. R1 resections were obtained in 27 patients (69.2%) and occurred more frequently in ACTs than PATs (93.3% vs. 54.2%, P = 0.006). Eighteen of 27 patients (66.7%) received adjuvant therapy (chemoradiotherapy [n = 11], radiotherapy alone [n = 7]) for R1 excision or re-excision, following which LRR developed in one of 10 (10.0%) patients in the ACT cohort and one of eight (12.5%) patients in the PAT cohort. There was no difference in 5-year LRR-free survival (82.0% vs. 70.1%, P = 0.252), disease-free survival (58.2% vs. 78.4%, P = 0.200) or overall survival (86.2% vs. 95.7%, P = 0.607) between the ACT and PAT cohorts.
LE is a feasible treatment option for early ASCCs of the perianal margin but not the anal canal. Acceptable long-term outcomes can still be achieved with adjuvant therapy in the presence of a positive margin. Larger prospective studies to assess LE as a treatment strategy, such as the ACT3 trial, are warranted.
关于早期肛管鳞状细胞癌（ASCC）局部切除（LE）后的预后数据较少。本研究旨在根据肿瘤位置（肛周[PAT]或肛管[ACT]）评估生存预后，并确定与R1切除相关的因素以及根据T分期的预后情况。
这是一项对2007年至2019年接受LE治疗的连续性早期ASCC患者的回顾性队列研究。收集了基线人口统计学、肿瘤位置、分期、切除组织学、辅助治疗、复发部位和时间的数据。主要结局指标为R1切除、局部区域复发（LRR）、无病生存和总生存。
在367例接受ASCC治疗的患者中，39例（10.6%）有完整随访数据的患者接受了LE：15例ACT和24例PAT。27例患者（69.2%）获得了R1切除，且在ACT中比在PAT中更频繁发生（93.3%对54.2%，P = 0.006）。27例患者中有18例（66.7%）因R1切除或再次切除接受了辅助治疗（放化疗[n = 11]，单纯放疗[n = 7]），之后ACT队列中的10例患者中有1例（10.0%）发生LRR，PAT队列中的8例患者中有1例（12.5%）发生LRR。ACT和PAT队列之间的5年无LRR生存率（82.0%对70.1%，P = 0.252）、无病生存率（58.2%对78.4%，P = 0.200）或总生存率（86.2%对95.7%，P = 0.607）无差异。
LE是肛周早期ASCC而非肛管早期ASCC的一种可行治疗选择。在切缘阳性的情况下，辅助治疗仍可实现可接受的长期预后。有必要开展更大规模的前瞻性研究来评估LE作为一种治疗策略，如ACT3试验。
