Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study

Sekhar, Hema; Zwahlen, Marcel; Trelle, Sven; Malcomson, Lee; Kochhar, Rohit; Saunders, Mark; Sperrin, Matthew; Herk, Marcel van; Sebag‐Montefiore, David; Egger, Matthias; Renehan, Andrew G

doi:10.1016/s1470-2045(17)30456-4

Cited by 44 publications

(28 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the improvement of imaging technology and surgical methods, the accuracy and sensitivity of finding positive LNs were greatly improved. Similarly, a study based on squamous cell carcinoma of the anus noted an increase in observed positive LN rate over time, which was summarized as the Will Rogers phenomenon ( 56 , 57 ).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Objectives: This study aimed to assess the effect of neoadjuvant chemotherapy (NACT) on the rate of lymph node metastasis (LNM) in FIGO stage IB1-IIB cervical cancer patients and compare the LNM between NACT plus surgery and surgery only. Methods: We identified 34 eligible studies in PubMed, Web of Science, Cochrane Library, and EMBASE from inception to July 27, 2019. Data analyses were performed by Stata (version 13) and Revman (version 5.3). Results: In these 34 included studies, the pooled incidence of LNM was estimated as 23% (95% CI, 0.20-0.26; I 2 = 79.6%, P<0.001). In the subgroup analysis, we identified five factors, including study type, year of publication, continents from which patients came, histological type and the FIGO stage. When taking FIGO stage into consideration, the LNM rate was 13% in stage IB (95% CI: 0.10-0.15; I 2 = 5.5%, P=0.385), 23% in stage IIA (95% CI: 0.18-0.28; I 2 = 0%, P=0.622), and 27% in stage IIB (95% CI: 0.20-0.33; I 2 = 0%, P=0.898), respectively. Through the comparison between NACT plus surgery and surgery only based on the six randomized controlled trials, the incidence of positive lymph nodes was lower in patients receiving NACT plus surgery than surgery only (RR=0.57, 95% CI: 0.39-0.83; I 2 = 60.5%, P=0.027). The 5-year OS was higher in the NACT + surgery group than surgery-only group (RR=1.13, 95% CI: 1.03-1.23; I 2 = 0.0%, P=0.842). Conclusions: Among cervical cancer in stage IB1-IIB, the preoperative NACT plus radical surgery resulted in a 23% probability of LNM, which was lower than those receiving radical surgery only. In stage IIA and IIB, the effect of NACT to reduce LNM was more obvious.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Recently a lymph node stage migration for anal cancer has been documented as a result of the use of MRI for detection of the primary tumour and regional lymph nodes and CT-FDG-PET for visualisation of malignant deposits [13]. The role of CT is today primarily to detect distant metastases and for planning of radiation therapy.…”

Section: Tnm 7 Crudementioning

confidence: 99%

Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version

et al. 2020

View full text Add to dashboard Cite

Background: The UICC TNM 7th edition introduced stage groups for anal cancer which in 2019 has not yet come into general use. The new TNM 8th edition from 2016 defines 7 sub-stages. Background data for these changes are lacking. We aimed to investigate whether the new classification for anal cancer reliably predict the prognosis in the different stages. Patients and methods: The Nordic Anal Cancer Group (NOAC) conducted a large retrospective study of all anal cancers in Norway, Sweden and most of Denmark in 2000-2007. From the Nordic cohort 1151 anal cancer patients with follow-up data were classified by the TNM 4th edition which has identical T, N and M definitions as the TNM 7th edition, and therefore also can be classified by the TNM 7th stage groups. We used the Nordic cohort to translate the T, N and M stages into the TNM 8th stages and sub-stages. Overall survival for each stage was assessed. Results: Although the summary stage groups for TNM 8th edition discriminates patients with different prognosis reasonably well, the analyses of the seven sub-stages show overlapping overall survival: HR for stage IIA 1.30 (95%CI 0.80-2.12) is not significantly different from stage I (p ¼ .30) and HR for stage IIB 2.35 (95%CI 1.40-3.95) and IIIA 2.48 (95%CI 1.43-4.31) are also similar as were HRs for stage IIIB 3.41 (95%CI 1.99-5.85) and IIIC 3.22 (95%CI 1.99-5.20). Similar overlapping was shown for local recurrence and distant spread. Conclusion: The results for the sub-stages calls for a revision of the staging system. We propose a modification of the TNM 8th edition for staging of anal cancer into four stages based on the T, N and M definitions of the TNM 8th classification.

show abstract

“…Five-year overall survival in patients with ASCC, treated by chemoradiotherapy, is approximately 75% [10]; it is therefore likely that many survivors are living with treatment-related side-effects.…”

Section: Introductionmentioning

confidence: 99%

“…Anal squamous cell carcinoma (ASCC) is a human papillomavirus (HPV)‐related malignancy , the incidence of which has increased two‐ to three‐fold in many populations , including the UK , in the last three decades. In the past 20 years, six Phase III randomized controlled trials (RCTs) determined the effectiveness of chemoradiotherapy as primary treatment in patients with ASCC, and it is now the primary treatment for 75–80% of patients . Locoregional failure occurs in 18–25% of patients and requires radical salvage surgery involving multidisciplinary approaches .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of outcome measures following chemoradiotherapy for the treatment of anal cancer (CORMAC)

et al. 2018

View full text Add to dashboard Cite

AimSix Phase III randomized trials have determined the effectiveness of chemoradiotherapy as primary treatment for anal squamous cell carcinoma (ASCC), but outcomes reported in these trials varied widely, hindering evidence synthesis. To improve reporting in all future trials, we aim to develop a core outcomes set (COS). As the first stage of COS development, we undertook a systematic review to summarize the outcomes reported in studies evaluating chemoradiotherapy for ASCC.MethodSystematic literature searches identified studies evaluating radiotherapy or chemoradiotherapy for ASCC. Outcomes and accompanying definitions were extracted verbatim and categorized into domains.ResultsFrom 5170 abstracts, we identified 95 eligible studies, reporting 1192 outcomes and 533 unique terms. We collapsed these terms into 86 standardized outcomes and five domains: survival; disease activity; life impact [including quality of life (QoL)]; delivery of care; and toxicity. The most commonly reported domains were survival and disease activity, reported in 74 (86%) and 54 (62%) studies, respectively. No outcome was reported in every publication. Over half (43/86) of the standardized outcome terms were reported in fewer than five studies, and 21 (25%) were reported in a single study only. There was wide variation in definitions of disease‐free survival, colostomy‐free survival and progression‐free survival (PFS). Anal continence was reported in only 35 (41%) studies.ConclusionOutcomes reported in studies evaluating chemoradiotherapy for ASCC were heterogenous and definitions varied widely. Outcomes likely to be important to patients, such as ano‐rectal function, toxicity and QoL, have been neglected. A COS for future trials will address these issues.

show abstract

Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study

Cited by 44 publications

References 51 publications

The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis

The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis

Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version

Systematic review of outcome measures following chemoradiotherapy for the treatment of anal cancer (CORMAC)

Contact Info

Product

Resources

About