Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK.
Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, Beckett Street, Leeds, LS9 7TF, UK.
BMC Cancer. 2022 Jun 3;22(1):607. doi: 10.1186/s12885-022-09729-4.
Anal cancer is primarily treated using concurrent chemoradiotherapy (CRT), with conformal techniques such as intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) now being the standard techniques utilised across the world. Despite this, there is still very limited consensus on prognostic factors for outcome following conformal CRT. This systematic review aims to evaluate the existing literature to identify prognostic factors for a variety of oncological outcomes in anal cancer, focusing on patients treated with curative intent using contemporary conformal radiotherapy techniques.
A literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results.
The results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study - pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors.
Establishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.
分析性癌症主要采用同步放化疗（CRT）治疗，目前全球标准技术为适形技术，如调强放疗（IMRT）和容积旋转调强放疗（VMAT）。尽管如此，对于 CRT 后一致性结果的预后因素仍存在非常有限的共识。本系统评价旨在评估现有文献，以确定分析性癌症多种肿瘤学结果的预后因素，重点关注采用现代适形放疗技术治疗的有治愈意图的患者。
通过 Medline 和 Embase 进行文献检索，以确定报告 CRT 后一致性治疗分析性癌症的生存和癌症相关结局的预后因素的研究。从单变量和多变量分析中确定为显著的预后因素，以及其各自的因素影响（如有），并进行提取。只有在超过一项研究中被报告为预后因素的因素才被包括在最终结果中。
对 19 项研究的结果进行了分析。在单变量和多变量分析中，N 分期、T 分期和性别被发现是大多数探索结果的最普遍和可靠的临床预后因素。只有少数生物标志物被超过一项研究确定为预后因素 - 治疗前活检 HPV 负荷，以及基线测量时白细胞增多、中性粒细胞增多和贫血的存在。结果还强调了缺乏研究探索成像因素的预后意义。
建立一组分析性癌症结局的预后和潜在预测因素可以指导患者的风险分层，有助于设计未来的临床试验。这些试验反过来将为我们提供更多的了解，以如何通过更个性化的方法有效地治疗这种疾病。
