Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Radiol Oncol. 2021 Oct 8;55(4):449-458. doi: 10.2478/raon-2021-0039.
Historically, the treatment of choice for anal cancer had been abdominoperineal resection (APR). Radical radiotherapy with concurrent 5-fluorouracil plus mitomycin C chemotherapy was later established as standard therapy, although with a failure rate of 20-30%. The aim of this study was to evaluate the outcomes after radical chemoradiotherapy (CRT), prognostic and predictive factors and patterns of failure.
This study included 47 patients treated with radical CRT for patohistologicaly confirmed anal squamous cell carcinoma. Analysed haematological parameters included: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and haemoglobin level. The final logistic regression model included treatment break period. Tumour response was assessed at 24 weeks from CRT completion. Follow-up was performed every 3 months during the first two years, and every 6 months thereafter.
A complete clinical response (CR) was detected in 30 patients (63.8%). Patients who did not achieve a 6-months CR and those who had a CR after 6 months but then relapsed were referred to surgical treatment. With combined CRT and surgical salvage treatment the CR rate was 80.9%. Patients with CR after 6 months had significantly longer disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). A significant effect on the 6-month response was confirmed for PLR ( = 0.03).
Important prognostic factors associated with CR were baseline haemoglobin level and period of treatment interruptions. Potential haematological prognostic factors could be PLR and NLR, which can be routinely determined by low-cost and minimally invasive methods.
historically，anal cancer 的治疗选择一直是 abdominoperineal resection（APR）。后来，放射治疗联合氟尿嘧啶加丝裂霉素 C 化疗被确立为标准治疗方法，尽管失败率仍有 20-30%。本研究旨在评估根治性放化疗（CRT）后的结果、预后和预测因素以及失败模式。
本研究纳入了 47 例经病理证实为 anal squamous cell carcinoma 的患者，接受根治性 CRT 治疗。分析的血液学参数包括：中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和血红蛋白水平。最终的逻辑回归模型包括治疗中断期。在 CRT 完成后 24 周评估肿瘤反应。在最初两年期间每 3 个月进行一次随访，此后每 6 个月进行一次随访。
30 例患者（63.8%）检测到完全临床反应（CR）。未达到 6 个月 CR 的患者和在 6 个月后达到 CR 但随后复发的患者均被转诊接受手术治疗。联合 CRT 和手术挽救治疗后，CR 率为 80.9%。在 6 个月后达到 CR 的患者无病生存（DFS）、无进展生存（PFS）和总生存（OS）显著延长。PLR（ = 0.03）对 6 个月反应的影响具有统计学意义。
与 CR 相关的重要预后因素是基线血红蛋白水平和治疗中断期。潜在的血液学预后因素可能是 PLR 和 NLR，它们可以通过成本低廉且微创的方法常规确定。
