Wale A, Bernier L, Tait D, Rao S, Brown G
St George's NHS Foundation Trust (Department of Radiology), Blackshaw Rd, London SW17 0QT, UK; St George's University of London (Molecular and Clinical Sciences Research Institute), Cranmer Terrace, London SW17 0RE, UK.
Radiation Oncology Service, Centre Hospitalier Universitaire de Québec, Québec, Canada, G1R 2J6.
Clin Radiol. 2025 Jan;80:106718. doi: 10.1016/j.crad.2024.10.001. Epub 2024 Oct 5.
This study aimed to determine the prognostic significance of length of tumour (mrT stage) and depth of extramural spread (mrEMS) in anal squamous cell cancer (SCC) treated by chemoradiation with curative intent. Locally advanced anal SCC (T3-4 N+) have poorer prognosis, but it is unknown whether the lateral spread of the tumour (extramural spread beyond the bowel wall) also confers poor prognosis in anal SCC, as it does for rectal cancer. T stage and mrEMS can be readily assessed by pelvic magnetic resonance imaging (MRI) routinely undertaken to stage anal SCC.
125 patients were included. Baseline mrT, mrN and mrEMS were assessed with response to chemoradiation and outcomes. Receiver operating curve (ROC) curve was used to determine a binary cut-off for mrEMS according to 3-year progression- free survival (PFS).
43% were mrT3-4 and 38% were mrEMS at baseline. 87% achieved mrCR. 3-year PFS and overall survival (OS) were 70.6% and 82%. On univariate analysis worse 3-year PFS was seen for mrT3-4 (HR 3.105), mrEMS (HR 4.924) and failure to achieve mrCR (HR 20.591). By univariate analysis, worse 3-year OS was seen for mrT3-4 (HR 4.134), mrEMS (HR 10.251) and failure to achieve mrCR (HR 19.289). On multivariate analysis, only mrEMS and failure to achieve mrCR remained prognostic. mrN was not prognostic.
MrEMS is a simple prognostic imaging biomarker for poorer survival which can be readily assessed by radiologists on routine imaging. mrEMS should be considered as a future stratification variable to identify high-risk SCC and consider escalation of treatment and surveillance strategies.
本研究旨在确定肿瘤长度（mrT分期）和壁外扩散深度（mrEMS）在接受根治性放化疗的肛管鳞状细胞癌（SCC）中的预后意义。局部晚期肛管SCC（T3 - 4 N +）预后较差，但肿瘤的侧向扩散（肠壁外的壁外扩散）是否也像直肠癌那样在肛管SCC中预示预后不良尚不清楚。T分期和mrEMS可通过常规用于肛管SCC分期的盆腔磁共振成像（MRI）轻松评估。
纳入125例患者。评估基线mrT、mrN和mrEMS以及放化疗反应和结局。采用受试者操作特征（ROC）曲线根据3年无进展生存期（PFS）确定mrEMS的二元临界值。
基线时43%为mrT3 - 4，38%为mrEMS。87%达到mrCR。3年PFS和总生存期（OS）分别为70.6%和82%。单因素分析显示，mrT3 - 4（HR 3.105）、mrEMS（HR 4.924）以及未达到mrCR（HR 20.591）的患者3年PFS较差。单因素分析显示，mrT3 - 4（HR 4.134）、mrEMS（HR 10.251）以及未达到mrCR（HR 19.289）的患者3年OS较差。多因素分析显示，只有mrEMS和未达到mrCR仍具有预后意义。mrN无预后意义。
mrEMS是一种简单的预后影像学生物标志物，提示较差的生存率，放射科医生可通过常规影像学轻松评估。mrEMS应被视为未来的分层变量，以识别高危SCC，并考虑加强治疗和监测策略。
