James Cook University Hospital, Middlesbrough, UK.
Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
Ann R Coll Surg Engl. 2021 Mar;103(3):191-196. doi: 10.1308/rcsann.2020.7019.
Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre.
All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival.
A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival ( = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), ( = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex ( = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size ( = 0.01, HR=1.64; 95% CI 1.12-2.41).
In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.
鳞状细胞癌是肛门恶性肿瘤最常见的变异型。某些与疾病相关的因素已被确定可影响生存。这些因素包括肿瘤大小、分化程度和淋巴结受累情况。其他因素，如 HIV 状态、人乳头瘤病毒感染、吸烟和社会经济差异，可能具有重要作用，但英国人群的数据很少。我们旨在分析三级中心肛门癌患者的社会贫困程度与生存情况的相关性。
纳入 2010 年 7 月至 2017 年 4 月期间，根据当地方案治疗的所有连续诊断为肛门鳞状细胞癌的病例。从前瞻性维护的数据库中收集了病理和人口统计学详细信息。每个邮政编码的社会经济贫困程度都使用英格兰地方政府编制的多因素剥夺指数进行定义。使用 Kaplan-Meier 分析估计生存情况，并使用 Cox 回归分析调查不同因素对总生存的影响。
共纳入 129 例肛门鳞状细胞癌患者，中位随访时间为 43 个月。整个患者队列的总体生存率为 87.7%（95%置信区间，82.0-93.7%）、75.5%（95%置信区间 67.5-84.5%）和 68.9%（95%置信区间 59.7-79.6%），分别为 1 年、3 年和 5 年。多变量分析显示，多因素剥夺指数和收入对总体生存率没有显著影响（=0.79，风险比，HR，1.07；95%置信区间 0.61-1.63），（=0.99，HR=1.00；95%置信区间 0.61-1.63）。男性（=0.02，HR=2.80；95%置信区间 1.02-5.50）和较大的肿瘤大小（=0.01，HR=1.64；95%置信区间 1.12-2.41）与死亡风险增加相关。
与美国的研究相比，在最贫困和最富裕人群之间，生存情况差异不大。我们认为这是由于能够平等获得基于调强放疗的放化疗。因此，一种对所有人都有效的高度有效的治疗方法，减轻了社会经济群体之间的任何生存差异。
