Taliadoros Vasilis, Rafique Henna, Rasheed Shahnawaz, Tekkis Paris, Kontovounisios Christos
Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK.
Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK.
Cancers (Basel). 2022 Jul 31;14(15):3738. doi: 10.3390/cancers14153738.
(1) Background: Anal canal adenocarcinomas constitute 1% of all gastrointestinal tract cancers. There is a current lack of consensus and NICE guidelines in the United Kingdom regarding the management of this disease. The overall objective was to perform a systematic review on the multitude of practice and subsequent outcomes in this group. (2) Methods: The MEDLINE, EMBASE, EMCARE and CINAHL databases were interrogated between 2011 to 2021. PRISMA guidelines were used to select relevant studies. The primary outcome measure was 5-year overall survival (OS). Secondary outcome measures included both local recurrences (LR) and distant metastases (DM). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies retrieved. The study was registered on PROSPERO (338286). (3) Results: Fifteen studies were included. Overall, there were 11,967 participants who were demographically matched. There were 2090 subjects in the largest study and five subjects in the smallest study. Treatment modalities varied from neoadjuvant chemoradiotherapy (CRT), CRT and surgery (CRT + S), surgery then CRT (S + CRT) and surgery only (S). Five-year OS ranged from 30.2% to 91% across the literature. LR rates ranged from 22% to 29%; DM ranged from 6% to 60%. Study heterogeneity precluded meta-analysis. (4) Conclusions: Trimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by radical surgery of abdominoperineal excision of rectum (APER) appeared to be the most effective approach, giving the best survival outcomes according to the current data.
(1) 背景：肛管腺癌占所有胃肠道癌症的1%。目前在英国，关于这种疾病的管理缺乏共识和英国国家卫生与临床优化研究所（NICE）指南。总体目标是对该组众多的实践及后续结果进行系统评价。(2) 方法：检索2011年至2021年期间的MEDLINE、EMBASE、EMCARE和CINAHL数据库。采用PRISMA指南选择相关研究。主要结局指标为5年总生存率（OS）。次要结局指标包括局部复发（LR）和远处转移（DM）。采用纽卡斯尔-渥太华量表（NOS）评估检索到的研究质量。该研究已在国际前瞻性系统评价注册库（PROSPERO）注册（338286）。(3) 结果：纳入15项研究。总体而言，有11967名参与者在人口统计学上匹配。最大的研究中有2090名受试者，最小的研究中有5名受试者。治疗方式包括新辅助放化疗（CRT）、CRT联合手术（CRT + S）、先手术后CRT（S + CRT）和单纯手术（S）。整个文献中5年OS率在30.2%至91%之间。LR率在22%至29%之间；DM率在6%至60%之间。研究异质性妨碍了荟萃分析。(4) 结论：根据目前的数据，新辅助放化疗（CRT）后行腹会阴联合直肠癌根治术（APER）的三联疗法似乎是最有效的方法，能带来最佳的生存结果。
