Tolmos J, Vargas H I, Lim S, Stamos M
Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA.
Am Surg. 1997 Oct;63(10):918-22.
Anal canal carcinoma is a rare clinical entity accounting for 1 to 3 per cent of all gastrointestinal malignancies. Abdominoperineal resection used to be the primary modality of treatment. However, recurrence rates of 20 to 40 per cent were observed after this mutilating procedure. In recent years, multimodality therapy with radiation and chemotherapy has shown at least equal results with the intention to preserve sphincter function. The objective of this study is to describe our experience at Harbor-UCLA Medical Center during the past 4 decades (1955-95), emphasizing changes in demographics, clinical presentation, and impact of multimodality therapy. Seventy-eight patients with the diagnosis of anal canal carcinoma were included. A steady increase in the incidence of anal carcinoma in younger people was observed (24% less than 64 years old for the 1955-65 period versus 75% for 1986-95 period). A female predominance was found in 1955-65 period, with F:M ratio 1.5, and a majority of male cases was seen in the last period (1986-95). Abdominoperineal resection was the preferred treatment during 1955-65, whereas during 1986-95 chemoradiation was the treatment of choice. We observed a trend from primary surgical treatment toward chemoradiotherapy with improvement in survival and preservation of ano-rectal function. Since 1988, we have not performed an abdominoperineal resection for primary treatment of anal carcinoma. Survival analysis was made grouping the patient population according to primary treatment. Higher survival rates were observed in the groups that received chemoradiotherapy (P = 0.0368) either as adjuvant or primary therapy. Chemoradiotherapy should be recommended as primary therapy to most patients.
肛管癌是一种罕见的临床病症，占所有胃肠道恶性肿瘤的1%至3%。腹会阴联合切除术曾是主要的治疗方式。然而，在这种致残性手术后，复发率为20%至40%。近年来，放疗和化疗的多模式治疗已显示出至少相当的效果，旨在保留括约肌功能。本研究的目的是描述我们在哈珀-加州大学洛杉矶分校医学中心过去40年（1955 - 1995年）的经验，重点关注人口统计学、临床表现的变化以及多模式治疗的影响。纳入了78例诊断为肛管癌的患者。观察到年轻人肛管癌发病率稳步上升（1955 - 1965年小于64岁的患者占24%，而1986 - 1995年为75%）。在1955 - 1965年期间发现女性居多，男女比例为1.5，而在最后一个时期（1986 - 1995年）男性病例占多数。1955 - 1965年期间，腹会阴联合切除术是首选治疗方法，而在1986 - 1995年期间，放化疗是首选治疗方法。我们观察到从主要手术治疗向放化疗的趋势，生存率提高且肛门直肠功能得以保留。自1988年以来，我们未对肛管癌的初始治疗进行腹会阴联合切除术。根据初始治疗对患者群体进行分组进行生存分析。接受放化疗作为辅助或初始治疗的组生存率更高（P = 0.0368）。应向大多数患者推荐放化疗作为初始治疗。
