Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields, Adam C.; Melnitchouk, Nelya; Senturk, James; Irani, Jennifer; Bleday, Ronald; Goldberg, Joel

doi:10.1002/jso.25489

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…The largest cohort to address the timing of salvage APR was collected from the National Cancer Database (NCDB) by Fields et al and included 437 patients treated between 2004 and 2013. The results yielded no significant differences in overall survival between patients who underwent salvage APR within 6 months of CRT (early) and beyond 6 months of treatment (late) [31]. Our present study corroborates this finding as an indication that APR (recurrent vs. persistent disease) did not influence survival outcomes.…”

Section: Discussionsupporting

confidence: 86%

Oncologic Outcomes of Salvage Abdominoperineal Resection for Anal Squamous Cell Carcinoma Initially Managed with Chemoradiation

Rosen,

Quezada-Diaz,

Gönen

et al. 2024

JCM

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Background: Abdominoperineal resection (APR) has been advocated for persistent or recurrent disease after failure of chemoradiation (CRT) for anal squamous cell cancer (SCC). Treatment with salvage APR can potentially achieve a cure. This study aimed to analyze oncological outcomes for salvage APR in a recent time period at a comprehensive cancer center. Methods: A retrospective review of all patients who underwent APR for biopsy-proven persistent or recurrent anal SCC between 1 January 2007 and 31 December 2020 was performed. Patients with stage IV disease at the time of initial diagnosis and patients with missing data were excluded. Univariate analysis was used with a chi-square test for categorical variables, and non-parametric tests were used for continuous variables. Kaplan–Meier survival analysis was performed to evaluate disease-specific (DSS), post-APR local recurrence-free (RFS), and disease-free survival (DFS). Results: A total of 96 patients were included in the analysis: 39 (41%) with persistent disease and 57 (59%) with recurrent SCC after chemoradiation had been completed. The median follow-up was 22 months (IQR 11–47). Forty-nine patients (51%) underwent extended APR and/or pelvic exenteration. Eight (8%) patients developed local recurrence, 30 (31%) developed local and distant recurrences, and 16 (17%) developed distant recurrences alone. The 3-year DSS, post-APR local recurrence-free survival, and disease-free survival were 53.8% (95% CI 43.5–66.5%), 54.5% (95% CI 44.4–66.8%), and 26.8% (95% CI 18.6–38.7%), respectively. In multivariate logistic regression analysis, positive microscopic margin (OR 10.0, 95% CI 2.16–46.12, p = 0.003), positive nodes in the surgical specimen (OR 9.19, 95% CI 1.99–42.52, p = 0.005), and lymphovascular invasion (OR 2.61 95% CI 1.05–6.51, p = 0.04) were associated with recurrence of disease. Gender, indication for APR (recurrent vs. persistent disease), HIV status, extent of surgery, or type of reconstruction did not influence survival outcomes. Twenty patients had targeted tumor-sequencing data available. Nine patients had PIK3CA mutations, seven of whom experienced a recurrence. Conclusions: Salvage APR for anal SCC after failed CRT was associated with poor disease-specific survival and low recurrence-free survival. Anal SCC patients undergoing salvage APR should be counseled that microscopic positive margins, positive lymph nodes, or the presence of lymphovascular invasion in the APR specimen are prognosticators for disease relapse. Our results accentuate the necessity for additional treatment strategies for the ongoing treatment challenge of persistent or recurrent anal SCC after failed CRT.

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Section: Discussionsupporting

confidence: 86%

Oncologic Outcomes of Salvage Abdominoperineal Resection for Anal Squamous Cell Carcinoma Initially Managed with Chemoradiation

Rosen,

Quezada-Diaz,

Gönen

et al. 2024

JCM

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“…Predictors of worse outcomes include positive lymph nodes and positive surgical margins. 94,95 Standard surveillance for cCR patients includes physical examination, digital anorectal examination, anoscopy/flexible sigmoidoscopy, and inguinal lymph node examination for the first 5 years. 51 An annual CT scan is recommended for the first 3 years of surveillance.…”

Section: Surveillance and The Role Of The Surgeonmentioning

confidence: 99%

“…93 Approximately 10%-30% of patients will have either persistent or recurrent disease, for whom abdominal perineal resection is recommended. 94,95 The 5-year OS and DFS rates after salvage abdominal perineal resection are 39%-51% and 44%-47%, respectively. Predictors of worse outcomes include positive lymph nodes and positive surgical margins.…”

Section: Treatment For Local Sccamentioning

confidence: 99%

Anal Cancer: Emerging Standards in a Rare Disease

Eng

Ciombor

Cho

et al. 2022

JCO

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The social stigma surrounding an anal cancer diagnosis has traditionally prevented open discussions about this disease. However, as recent treatment options and an increasing rate of diagnoses are made worldwide, awareness is growing. In the United States alone, 9,090 individuals were expected to be diagnosed with anal cancer in 2021. The US annual incidence of squamous cell carcinoma of the anus continues to increase by 2.7% yearly, whereas the mortality rate increases by 3.1%. The main risk factor for anal cancer is a human papillomavirus infection; those with chronic immunosuppression are also at risk. Patients with HIV are 19 times more likely to develop anal cancer compared with the general population. In this review, we have provided an overview of the carcinoma of the anal canal, the role of screening, advancements in radiation therapy, and current trials investigating acute and chronic treatment–related toxicities. This article is a comprehensive approach to presenting the existing data in an effort to encourage continuous international interest in anal cancer.

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“…after failure of chemoradiotherapy is similar. As a result, the authors concluded that patients with persistent disease should be offered surgery just as readily as those with recurrent disease [77]. Finally, preoperatory imaging should be used to assist in patient selection, to identify those patients in whom negative margins can be obtained and to determine an appropriate rescue surgery.…”

Section: Treatment Of Progressive or Recidivant Acmentioning

confidence: 99%