Frost D B, Richards P C, Montague E D, Giacco G G, Martin R G
Cancer. 1984 Mar 15;53(6):1285-93. doi: 10.1002/1097-0142(19840315)53:6<1285::aid-cncr2820530611>3.0.co;2-n.
The optimal treatment for squamous and cloacogenic tumors of the anorectum is controversial. Radical surgery, limited surgery, and radiotherapy (XRT) are all potentially curative. This study was undertaken to determine which patients are candidates for each type of treatment and which would benefit from combined treatment. The records of 192 patients treated at this institution between 1954 and 1979 with the diagnosis of squamous or cloacogenic carcinoma of the anorectum were retrospectively reviewed. A subgroup of 132 patients undergoing abdominal perineal resection (APR) was analyzed to determine prognostic factors for these tumors. No survival difference was observed between the two histologic types (P = 0.51). Prognostic variables significant at P = 0.05 or better were sex, size, nodal status, and level of invasion. A new staging system is proposed that utilizes tumor size, invasion, grade, and nodal status. Actuarial 10-year survival was 100%, 76%, 29%, and 0% for Stages A, B, C and D, respectively (P values 0.22, 0.0007, and 0.01, respectively). Twelve patients undergoing APR received postoperative XRT; when compared by stage with APR alone no survival difference can be shown, although there is a trend towards fewer local recurrences. Of 26 patients (14 Stage B, 12 Stage C) receiving preoperative XRT (average 4000 R) before APR, 10 had inoperable tumors prior to XRT. All became operable. Eight patients had negative surgical margins and survival was equivalent stage for stage to the operable group (Stage B 78%, 5-year survival; Stage C 43%, 5-year survival). Eleven patients had no demonstrable primary tumor after XRT, although three had nodal metastasis. Five-year survival was 83% for this group. Thirty-one local recurrences were retreated for cure by surgery, XRT, or combination. Actuarial 5-year survival after retreatment was 38%. Thirty metachronous inguinal metastases were seen, 20 were retreated for cure, 18 by inguinal lymphadenectomy. Actuarial 5-year survival was 42%. Using a new staging system based on analysis of prognostic parameters for this disease, the outcome of combined surgery and XRT is compared. The efficacy of preoperative XRT for inoperable tumors is demonstrated. An appreciable salvage rate for local or inguinal recurrence was observed.
肛管直肠鳞状上皮癌和泄殖腔源癌的最佳治疗方法存在争议。根治性手术、局限性手术和放射治疗（XRT）都有潜在的治愈可能。本研究旨在确定哪些患者适合每种治疗方式，以及哪些患者能从联合治疗中获益。对1954年至1979年间在本机构接受肛管直肠鳞状或泄殖腔源癌诊断治疗的192例患者的记录进行了回顾性分析。对132例行腹会阴联合切除术（APR）的患者亚组进行分析，以确定这些肿瘤的预后因素。两种组织学类型之间未观察到生存差异（P = 0.51）。P = 0.05或更低水平时具有显著意义的预后变量为性别、肿瘤大小、淋巴结状态和浸润深度。提出了一种新的分期系统，该系统利用肿瘤大小、浸润情况、分级和淋巴结状态。A、B、C和D期的10年精算生存率分别为100%、76%、29%和0%（P值分别为0.22、0.0007和0.01）。12例行APR的患者接受了术后XRT；与单纯APR按分期比较，未显示出生存差异，尽管局部复发有减少的趋势。26例（14例B期，12例C期）在APR前接受术前XRT（平均4000 R）的患者中，10例在XRT前存在无法手术切除的肿瘤。所有患者均变为可手术切除。8例患者手术切缘阴性，各分期的生存率与可手术组相当（B期5年生存率78%；C期5年生存率43%）。11例患者在XRT后未发现明显原发肿瘤，尽管3例有淋巴结转移。该组5年生存率为83%。31例局部复发患者通过手术、XRT或联合治疗进行了挽救性治疗。挽救性治疗后的5年精算生存率为38%。观察到30例异时性腹股沟转移，20例进行了挽救性治疗，18例通过腹股沟淋巴结清扫术。5年精算生存率为42%。使用基于该疾病预后参数分析的新分期系统，比较了手术和XRT联合治疗的结果。证明了术前XRT对无法手术切除肿瘤的疗效。观察到局部或腹股沟复发有可观的挽救率。
