Primary tumor size as a prognosticator in anal cancer patients

Franco, Pierfrancesco; Ricardi, Umberto

doi:10.21037/atm.2019.03.16

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…[22][23][24][25][26] In addition, the increased accuracy C. 12 It is well established that larger tumors with a more hypoxic environment are less radiosensitive, making them more difficult to treat and contributing to worse overall survival. 27 Our findings are reflective of the TN category data captured by the US Gastrointestinal Intergroup Radiation Therapy Oncology Group (RTOG) 98-11 anal cancer trial (ClinicalTrials.gov identifier NCT00003596), which demonstrated worse survival outcomes for larger tumors than for node-positive disease. 28 Although their results demonstrate hierarchical prognostication with advancing TN categories, a subset of patients with involved lymph nodes had a better prognosis than those with higher T-category, node-negative disease.…”

Section: Key Stage Group Changessupporting

confidence: 54%

“…Definitive chemoradiation still includes pelvic radiotherapy as well as the combination of 5‐fluorouracil–based chemotherapy with mitomycin C 12 . It is well established that larger tumors with a more hypoxic environment are less radiosensitive, making them more difficult to treat and contributing to worse overall survival 27 . Our findings are reflective of the TN category data captured by the US Gastrointestinal Intergroup Radiation Therapy Oncology Group (RTOG) 98‐11 anal cancer trial (ClinicalTrials.gov identifier NCT00003596), which demonstrated worse survival outcomes for larger tumors than for node‐positive disease 28 .…”

Section: Discussionmentioning

confidence: 99%

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Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer

Janczewski,

Faski,

Nelson

et al. 2023

CA A Cancer J Clinicians

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The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long‐term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1–T2N1M0 disease, (2) redefined stage IIIA as T3N0–N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.

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Section: Key Stage Group Changessupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer

Janczewski,

Faski,

Nelson

et al. 2023

CA A Cancer J Clinicians

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show abstract

“…Since fifty percent of recurrences occurring within the first 2 years post treatment, are located around the primary site of disease, or as pelvic/inguinal lymph nodes, a loco regional staging system with a positive impact on prognosis is of paramount importance in order to stratify patients into appropriate risk categories and possibly tailor treatment plans[ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of ultrasonography staging in patients with anal cancer

Nardi¹,

Arru²,

Guarneri³

et al. 2020

WJGO

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BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease; however, we propose including a novel ultrasound (US) staging system, based on depth of tumor invasion. In this study the clinical American Joint Committee on Cancer (AJCC) staging guidelines and the US classificationss in patients with anal cancer were compared. AIM To evaluate the prognostic role of the US staging system in patients with anal cancer. METHODS The data of 48 patients with anal canal squamous cells carcinoma, observed at our University Hospital between 2007 and 2017, who underwent pre-treatment assessment with pelvic magnetic resonance imaging (MRI), total body computed tomography (CT) scan and endoanal US were retrospectively reviewed. Anal canal tumors were clinically staged according to AJCC, determined by MRI by measurement of the longest tumor diameter, and CT scan. Endoanal US was performed with a high multi-frequency (9-16 MHz), 360° rotational mechanical probe; US classification was based on depth of tumor penetration through the anal wall, according to Giovannini’s study. All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C. After treatment patients were followed-up regularly. RESULTS At baseline there were 30 and 32 T1-2, 18 and 16 T3-4, 31 and 19 N+ patients classified according to the clinical AJCC and US staging system respectively. After a mean follow-up of 98 months, 38 patients (79.1%) are alive and 28 (58.3%) are disease free. During follow up 20 patients (41.6%) experienced recurrences. After univariate analysis, American Society of Anesthesiologists (ASA) score ( P = 0.00000001) and US staging ( P = 0.009) were significantly related to disease-free survival (DFS). When overall survival and DFS functions were compared, a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging. By combining the 2 significant prognostic variables, namely the US staging with the ASA score, four risks groups with different prognoses were identified. CONCLUSION Our findings suggest that US staging may be superior to traditional clinical staging, since it is significantly associated with DFS in anal cancer patients.

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A Population‐Level Validation of the New 9th Edition of the American Joint Commission on Cancer Staging System for Anal Squamous Cell Carcinoma

Karim,

Troester,

Mott

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesThe staging system for anal squamous cell carcinoma (ASCC) was recently revised, downstaging selected node‐positive patients and upstaging some with larger tumors. We aimed to validate this staging system using a population‐based cohort.MethodsThe Surveillance, Epidemiology, and End Results database was analyzed to identify adult ASCC patients. Patients were staged according to the American Joint Committee on Cancer (AJCC) 8th and 9th edition systems. Survival probabilities were estimated using Kaplan‐Meier curves. Cox regression models were utilized to estimate the effect of stage on overall (OS) and cancer‐specific survival (CSS).ResultsA total of 2117 patients were identified and staged based on the two AJCC classifications. At 24 months when comparing stage IIB versus stage IIIA, the 8th edition revealed an improved OS (79% vs. 88%) and CSS (84% vs. 91%) for stage IIIA disease, while the 9th edition restored the hierarchical OS (IIB 88% vs. IIIA 78%) and CSS (91% vs. 82%) order.ConclusionsThe hierarchical increase of the OS HRs, and nearly all CSS HRs, across disease stages validated the updated edition of the AJCC classification. Although this change may not have significant implication on the management of ASCC, it does provide better prognostication.

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Primary tumor size as a prognosticator in anal cancer patients

Cited by 3 publications

References 13 publications

Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer

Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer

Prognostic role of ultrasonography staging in patients with anal cancer

A Population‐Level Validation of the New 9th Edition of the American Joint Commission on Cancer Staging System for Anal Squamous Cell Carcinoma

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