TY - JOUR
T1 - Anal Squamous Cell Carcinoma
T2 - Radiation Therapy Alone Must Be Avoided
AU - Almaazmi, Hamda
AU - Taylor, James P.
AU - Stem, Miloslawa
AU - Yu, David
AU - Lo, Brian D.
AU - Safar, Bashar
AU - Efron, Jonathan E.
N1 - Funding Information:
Mr. Edwin Lewis provided generous support of Dr. Efron's Department of Surgery Research Fund. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: H.A. and J.P.T. contributed to design of the work, interpretation of data, drafting and revising the work, and final approval. M.S. contributed to design of the work, data analysis, interpretation of data, drafting and revising the work, and final approval. D.Y. contributed to concept and design of the work, revising the work, and final approval. B.D.L. contributed to design of the work, interpretation of data, drafting and revising the work, and final approval. B.S. contributed to interpretation of data, revising the work, and final approval. J.E.E. contributed to concept and design of the work, interpretation of data, revising the work, and final approval. All authors agree to be accountable for all aspects of the work. Disclaimers: The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the deidentified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/3
Y1 - 2020/3
N2 - Background: Anal squamous cell carcinoma (ASCC) is the most common histological subtype of anal cancer. Rates have been observed to increase in recent years. Combined chemoradiotherapy (CCRT) is currently the gold standard of treatment. The aim of this study is to assess ASCC prevalence, treatment trends, and overall survival (OS) in the United States. Methods: Patients diagnosed with stage I–IV ASCC were identified from the National Cancer Database from 2004 to 2015. The primary outcome was 5-year OS, which was analyzed using Kaplan–Meier survival curves, log-rank test, and Cox proportional hazards models. Results: 34,613 cases were included (stage I: 21.45%; II: 41.00%; III: 31.62%; IV: 5.94%), with an increasing trend in prevalence. CCRT was the most used treatment. Multimodal treatment, combining surgery with CCRT, offered the best OS rates for stage I, II, and IV cancers (I: 84.87%; II: 75.12%; IV: 33.08%), comparable with survival of stage III patients treated with CCRT (III: 61.14%). Radiation alone had the worse OS rates, and on adjusted analysis, radiation treatment alone had the greatest risk of mortality (I: hazard ratio, 2.01; 95% confidence interval, 1.14-3.54; P = 0.016; II: 2.05, 1.44-2.93, P < 0.001; IV: 1.99, 0.99-4.02, P = 0.054). Conclusions: ASCC has increased in prevalence, notably in stage III and IV disease. Although CCRT is the most commonly used treatment type for all stages of ASCC, multimodal treatment offers better OS in stages I, II, and IV. Treatment with radiation alone offers the worst OS no matter the stage and should no longer be used as a solitary treatment modality.
AB - Background: Anal squamous cell carcinoma (ASCC) is the most common histological subtype of anal cancer. Rates have been observed to increase in recent years. Combined chemoradiotherapy (CCRT) is currently the gold standard of treatment. The aim of this study is to assess ASCC prevalence, treatment trends, and overall survival (OS) in the United States. Methods: Patients diagnosed with stage I–IV ASCC were identified from the National Cancer Database from 2004 to 2015. The primary outcome was 5-year OS, which was analyzed using Kaplan–Meier survival curves, log-rank test, and Cox proportional hazards models. Results: 34,613 cases were included (stage I: 21.45%; II: 41.00%; III: 31.62%; IV: 5.94%), with an increasing trend in prevalence. CCRT was the most used treatment. Multimodal treatment, combining surgery with CCRT, offered the best OS rates for stage I, II, and IV cancers (I: 84.87%; II: 75.12%; IV: 33.08%), comparable with survival of stage III patients treated with CCRT (III: 61.14%). Radiation alone had the worse OS rates, and on adjusted analysis, radiation treatment alone had the greatest risk of mortality (I: hazard ratio, 2.01; 95% confidence interval, 1.14-3.54; P = 0.016; II: 2.05, 1.44-2.93, P < 0.001; IV: 1.99, 0.99-4.02, P = 0.054). Conclusions: ASCC has increased in prevalence, notably in stage III and IV disease. Although CCRT is the most commonly used treatment type for all stages of ASCC, multimodal treatment offers better OS in stages I, II, and IV. Treatment with radiation alone offers the worst OS no matter the stage and should no longer be used as a solitary treatment modality.
KW - Anal cancer
KW - Chemoradiation
KW - Epidermoid carcinoma
KW - Squamous cell carcinoma
KW - Survival
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U2 - 10.1016/j.jss.2019.09.049
DO - 10.1016/j.jss.2019.09.049
M3 - Article
C2 - 31648811
AN - SCOPUS:85073836066
SN - 0022-4804
VL - 247
SP - 530
EP - 540
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -