肛管鳞状细胞癌放化疗前后恶性肿瘤发生率增加：一项多机构分析。

Increased occurrence of malignancy before and after chemoradiation for anal squamous cell carcinoma: a multi-institutional analysis.

作者信息

Kumar Ritesh, Hallemeier Chris L, Chang Daniel T, Lu Shou-En, Hathout Lara, Hristidis Vasilis C, Jethwa Krishnan R, Baclay J Richelcyn M, Manne Veeraswamy, Chakrani Zakaria, Haddock Michael G, Toesca Diego Augusto Santos, Pollom Erqi Liu, Wu Abraham J, Sandhyavenu Harigopal, Romesser Paul B, Jabbour Salma K

机构信息

Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, United States.

Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States.

出版信息

J Natl Cancer Inst. 2025 Apr 1;117(4):772-780. doi: 10.1093/jnci/djae309.

DOI:10.1093/jnci/djae309

PMID:39626307

Abstract

BACKGROUND

Anal squamous cell carcinoma is a rare cancer with increased occurrence of multiple cancers before and after the anal squamous cell carcinoma diagnosis. However, there are limited data on this aspect. This multi-institutional analysis aimed to define the occurrence of malignancies before and after anal squamous cell carcinoma, time trends, and impact on survival and to identify prognostic factors.

METHODS

Initial primary malignancy was defined as a malignancy occurring before the anal squamous cell carcinoma. Second primary malignancy was defined as a distinct primary cancer that developed after anal squamous cell carcinoma diagnosis. Retrospective multi-institutional chart review was done. Progression-free survival (PFS), overall survival, and prognostic factors were evaluated.

RESULTS

A total of 647 patients with anal squamous cell carcinoma treated with curative intent were analyzed. Median age was 61.2 years with 72% as females. Of these, 150 (23.3%) patients had multiple malignancies with initial primary malignancy in 16% and second primary malignancy in 8%. Patients without prior cancer had better 5-year PFS (81.2% vs 67.2%, P = .011) and overall survival (81% vs 69%, P = .008) compared with those with prior cancer. Second primary malignancies had a statistically significant adverse impact on PFS (hazard ratio [HR] = 4.22) and overall survival (HR = 3.56). Females had better 5-year PFS (82% vs 70%, P = .016) as compared with males. The median time interval for developing anal squamous cell carcinoma (as second primary malignancy) after initial primary malignancy was 9.32 years.

CONCLUSIONS

Anal squamous cell carcinoma patients have an increased risk of multiple malignancies. These patients who have prior cancers have inferior outcomes. Second primary malignancy is a poor prognostic factor in patients with anal cancer. Second primary malignancy can develop years after treatment of primary anal squamous cell carcinoma.

摘要

背景

肛管鳞状细胞癌是一种罕见的癌症，在肛管鳞状细胞癌诊断前后发生多种癌症的情况有所增加。然而，这方面的数据有限。这项多机构分析旨在确定肛管鳞状细胞癌前后恶性肿瘤的发生情况、时间趋势及其对生存的影响，并确定预后因素。

方法

初始原发性恶性肿瘤定义为在肛管鳞状细胞癌之前发生的恶性肿瘤。第二原发性恶性肿瘤定义为在肛管鳞状细胞癌诊断后发生的不同原发性癌症。进行了回顾性多机构病历审查。评估了无进展生存期（PFS）、总生存期和预后因素。

结果

共分析了647例接受根治性治疗的肛管鳞状细胞癌患者。中位年龄为61.2岁，女性占72%。其中，150例（23.3%）患者患有多种恶性肿瘤，初始原发性恶性肿瘤占16%，第二原发性恶性肿瘤占8%。与有既往癌症的患者相比，无既往癌症的患者5年PFS更好（81.2%对67.2%，P = 0.011），总生存期也更好（81%对69%，P = 0.008）。第二原发性恶性肿瘤对PFS（风险比[HR]=4.22）和总生存期（HR = 3.56）有统计学上的显著不利影响。女性的5年PFS优于男性（82%对70%，P = 0.016）。初始原发性恶性肿瘤后发生肛管鳞状细胞癌（作为第二原发性恶性肿瘤）的中位时间间隔为9.32年。