Top

International Journal of Colorectal Disease

Published in:

01-04-2019 | Cytostatic Therapy | Original Article

Surgery and chemotherapy are associated with improved overall survival in anal adenocarcinoma: results of a national cohort study

Authors: Nicholas P. McKenna, John R. Bergquist, Elizabeth B. Habermann, Heidi K. Chua, Scott R. Kelley, Kellie L. Mathis

Published in: International Journal of Colorectal Disease | Issue 4/2019

Abstract

Purpose

Anal adenocarcinoma (AAC) is a rare disease with treatment protocols that mimic both that of rectal adenocarcinoma (RAC) and anal squamous cell carcinoma (ASCC). Due to its rarity, data regarding outcomes are lacking. We sought to determine outcomes of patients with AAC compared to RAC and ASCC and to evaluate risk factors for mortality in AAC.

Methods

The United States’ National Cancer Database was queried for all adult patients presenting with nonmetastatic AAC, RAC, or ASCC from 2003 to 2011. The primary outcome was overall survival. Intergroup univariate comparisons, unadjusted Kaplan-Meier, and multivariable Cox proportional hazards modeling were used to compare outcomes between AAC, RAC, and ASCC and to identify factors associated with survival within AAC.

Results

The query identified 129,153 patients (N = 2117 AAC, 19,427 ASC, 107,609 RAC). AAC patients were less likely than RAC patients to have surgery (72.5 vs. 87.1%), and also less likely to receive chemotherapy (54.7% vs. 96.1%) and radiation (58.2% vs. 74.1%) than patients with ASCC (all p < 0.001). Overall median survival in AAC was 65 months compared to 109 months for RAC and > 120 months for ASCC. On multivariable analysis, independent treatment-related predictors of decreased mortality hazard in AAC included proctectomy (hazard ratio [HR], 0.66) and chemotherapy (HR, 0.60) (both p < 0.001).

Conclusion

AAC tumors have worse prognosis than either RAC or ASCC. Within patients with AAC, nonsurgical management was independently associated with increased mortality hazard. Patients with AAC should be evaluated in a multidisciplinary setting and referred for surgery.

Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. https://doi.org/10.3322/caac.21442 CrossRef

Leonard D, Beddy D, Dozois EJ (2011) Neoplasms of anal canal and perianal skin. Clin Colon Rectal Surg 24(1):54–63. https://doi.org/10.1055/s-0031-1272824 CrossRefPubMedPubMedCentral

Stewart DB, Gaertner WB, Glasgow SC, Herzig DO, Feingold D, Steele SR, Prepared on Behalf of the Clinical Practice Guidelines Committee of the American Society of C, Rectal S (2018) The American society of colon and rectal surgeons clinical practice guidelines for anal squamous cell cancers (revised 2018). Dis Colon rectum 61(7):755–774. https://doi.org/10.1097/DCR.0000000000001114

Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of C, Rectal S (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon rectum 56(5):535–550. https://doi.org/10.1097/DCR.0b013e31828cb66c

Chang GJ, Gonzalez RJ, Skibber JM, Eng C, Das P, Rodriguez-Bigas MA (2009) A twenty-year experience with adenocarcinoma of the anal canal. Dis Colon rectum 52(8):1375–1380. https://doi.org/10.1007/DCR.0b013e3181a79589

Beal KP, Wong D, Guillem JG, Paty PB, Saltz LL, Wagman R, Minsky BD (2003) Primary adenocarcinoma of the anus treated with combined modality therapy. Dis Colon rectum 46(10):1320–1324. https://doi.org/10.1097/01.DCR.0000089116.17611.07

Bertelson N, Blumetti J, Cintron J, Harrison J, Chaudhry V, Abcarian H (2015) Anal adenocarcinoma: outcomes in an uncommon malignancy. Am Surg 81(11):1114–1117PubMed

Bilimoria KY, Stewart AK, Winchester DP, Ko CY (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15(3):683–690. https://doi.org/10.1245/s10434-007-9747-3 CrossRefPubMedPubMedCentral

Raval MV, Bilimoria KY, Stewart AK, Bentrem DJ, Ko CY (2009) Using the NCDB for cancer care improvement: an introduction to available quality assessment tools. J Surg Oncol 99(8):488–490. https://doi.org/10.1002/jso.21173 CrossRefPubMed

10.

Franklin RA, Giri S, Valasareddy P, Lands LT, Martin MG (2016) Comparative survival of patients with anal adenocarcinoma, squamous cell carcinoma of the anus, and rectal adenocarcinoma. Clin Colorectal Cancer 15(1):47–53. https://doi.org/10.1016/j.clcc.2015.07.007 CrossRefPubMed

11.

Kounalakis N, Artinyan A, Smith D, Mojica-Manoso P, Paz B, Lai LL (2009) Abdominal perineal resection improves survival for nonmetastatic adenocarcinoma of the anal canal. Ann Surg Oncol 16(5):1310–1315. https://doi.org/10.1245/s10434-009-0392-x CrossRefPubMed

12.

Klas JV, Rothenberger DA, Wong WD, Madoff RD (1999) Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes. Cancer 85(8):1686–1693CrossRefPubMed

13.

Papagikos M, Crane CH, Skibber J, Janjan NA, Feig B, Rodriguez-Bigas MA, Hung A, Wolff RA, Delclos M, Lin E, Cleary K (2003) Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys 55(3):669–678CrossRefPubMed

14.

Joon DL, Chao MW, Ngan SY, Joon ML, Guiney MJ (1999) Primary adenocarcinoma of the anus: a retrospective analysis. Int J Radiat Oncol Biol Phys 45(5):1199–1205CrossRefPubMed

15.

Belkacemi Y, Berger C, Poortmans P, Piel G, Zouhair A, Meric JB, Nguyen TD, Krengli M, Behrensmeier F, Allal A, De Looze D, Bernier J, Scandolaro L, Mirimanoff RO, Rare Cancer N (2003) Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network. Int J Radiat Oncol Biol Phys 56(5):1274–1283CrossRefPubMed

16.

Longo WE, Vernava AM 3rd, Wade TP, Coplin MA, Virgo KS, Johnson FE (1995) Rare anal canal cancers in the U.S. veteran: patterns of disease and results of treatment. Am Surg 61(6):495–500PubMed

Title: Surgery and chemotherapy are associated with improved overall survival in anal adenocarcinoma: results of a national cohort study
Authors: Nicholas P. McKenna
John R. Bergquist
Elizabeth B. Habermann
Heidi K. Chua
Scott R. Kelley
Kellie L. Mathis
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keywords: Cytostatic Therapy
Anal Cancer
Anal Cancer
Published in: International Journal of Colorectal Disease / Issue 4/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-03232-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgery and chemotherapy are associated with improved overall survival in anal adenocarcinoma: results of a national cohort study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2019

Correction to: Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?

Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI)

D3 lymph node dissection reduces recurrence after primary resection for elderly patients with colon cancer

Correction to: Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years?

Circulating tumor cells as an independent prognostic factor in advanced colorectal cancer: a retrospective study in 121 patients

Preoperative T staging of colon cancer using CT colonography with multiplanar reconstruction: new diagnostic criteria based on “bordering vessels”