Grabenbauer G G, Matzel K E, Schneider I H, Meyer M, Wittekind C, Matsche B, Hohenberger W, Sauer R
Department of Radiation Oncology, University Hospitals of Erlangen-Nürnberg, Erlangen, Germany.
Dis Colon Rectum. 1998 Apr;41(4):441-50. doi: 10.1007/BF02235757.
This study contained herein assessed long-term results, toxicity, and prognostic variables following combined modality therapy of patients with International Union Against (Cancer Classification T1-4, N0-3, M0 squamous-cell carcinoma of the anal canal.
Between 1985 and 1996, 62 patients completed treatment with combined modality therapy. A median total dose of 50 Gy was given to the primary, perirectal, presacral, and inguinal nodes followed by a local boost in selected cases. 5-Fluorouracil was scheduled as a continuous infusion of 1,000 mg/m2 per 24 hours on days 1 to 5 and 29 to 33 and mitomycin C as a bolus of 10 mg/m2 on days 1 and 29. Routinely processed paraffin-embedded sections were stained using monoclonal antibodies for detection of proliferating cell nuclear antigen and MIB1 (Ki-67) antigen to determine the labeling index. In addition, DNA ploidy was assessed after Feulgen staining.
Actuarial cancer-related survival, no evidence of disease survival, and colostomy-free survival rates at five years were 81, 76, and 86 percent, respectively. In univariate analysis, T category (T1/2 vs. T3/4) was predictive for no evidence of disease survival (87 vs. 59 percent; P = 0.03) and colostomy-free survival (94 vs. 73 percent; P = 0.05). N category (N0 vs. N1-3) influenced actuarial cancer-related survival (85 vs. 58 percent; P = 0.002) and no evidence of disease survival (80 vs. 53 percent; P = 0.02). A higher proliferative potential as measured by the MIB1 labeling index was associated with a better colostomy-free survival (90 vs. 50 percent; P = 0.04). In multivariate analysis, actuarial cancer-related survival was only influenced by the N category (P = 0.03) and no evidence of disease survival by N category (P = 0.03) and mitomycin C dose (P = 0.04). Salvage abdominoperineal resection achieved long-term control in only four of seven patients with local failures.
Treatment with a combination of radiotherapy and chemotherapy is safe and effective for patients with anal canal carcinoma. Abdominoperineal resection is indicated as a salvage procedure in nonresponding and recurrent lesions and may be of benefit in a small subgroup of patients with poor prognostic factors.
本研究评估了国际抗癌联盟（UICC）分期为T1 - 4、N0 - 3、M0的肛管鳞状细胞癌患者接受综合治疗后的长期疗效、毒性及预后变量。
1985年至1996年间，62例患者完成了综合治疗。对原发灶、直肠周围、骶前及腹股沟淋巴结给予的中位总剂量为50 Gy，部分病例随后进行局部加量。5 - 氟尿嘧啶在第1至5天和第29至33天按每24小时1000 mg/m²持续输注，丝裂霉素C在第1天和第29天给予10 mg/m²的大剂量注射。常规处理的石蜡包埋切片用单克隆抗体染色，以检测增殖细胞核抗原和MIB1（Ki - 67）抗原，从而确定标记指数。此外，经福尔根染色后评估DNA倍体。
5年时精算的癌症相关生存率、无疾病证据生存率及无结肠造口生存率分别为81%、76%和86%。单因素分析中，T分期（T1/2与T3/4）可预测无疾病证据生存率（87%对59%；P = 0.03）及无结肠造口生存率（94%对73%；P = 0.05）。N分期（N0与N1 - 3）影响精算的癌症相关生存率（85%对58%；P = 0.002）及无疾病证据生存率（80%对53%；P = 0.02）。通过MIB1标记指数测量的较高增殖潜能与较好的无结肠造口生存率相关（90%对50%；P = 0.04）。多因素分析中，精算的癌症相关生存率仅受N分期影响（P = 0.03），无疾病证据生存率受N分期（P = 0.03）和丝裂霉素C剂量（P = 0.04）影响。挽救性腹会阴切除术仅使7例局部复发患者中的4例获得长期控制。
放疗与化疗联合治疗对肛管癌患者安全有效。腹会阴切除术适用于无反应和复发病变的挽救性手术，可能对一小部分预后不良因素的患者有益。
