Highlights
- •We evaluated survival outcomes after salvage APR for recurrent and persistent SCCA
- •We investigated the significance of salvage APR compared with non-salvage APR
- •Results will help the treatment strategy for the locoregional failure of SCCA after CRT
- •Results will help to improve the survival outcomes and patients' QoL
Abstract
Introduction
The primary treatment for locoregional failure following chemoradiotherapy for squamous
cell carcinoma of the anus (SCCA) is salvage abdominoperineal resection (APR). However,
it is necessary to distinguish between recurrent and persistent diseases because of
their varied pathologies. We aimed to clarify the survival outcomes following salvage
APR for recurrent and persistent diseases and investigate the significance of salvage
APR.
Materials and methods
This multicentre retrospective cohort study used clinical data from 47 hospitals.
All patients were diagnosed with SCCA and underwent definitive radiotherapy as the
primary treatment between 1991 and 2015. Overall survival (OS) was compared between
the following cohorts: salvage APR for recurrence, salvage APR for persistence, non-salvage
APR for recurrence, and non-salvage APR for persistence.
Results
Five-year OS of salvage APR for recurrence, salvage APR for persistence, non-salvage
APR for recurrence, and non-salvage APR for persistence were 75% (46%–90%), 36% (21%–51%),
42% (21%–61%), and 47% (33%–60%), respectively. OS of salvage APR for the recurrent
disease was significantly higher than that for persistent disease (p = 0.00597). For recurrent disease, OS following salvage APR was significantly higher than that
following non-salvage APR (p = 0.0204); however, for persistent disease, there was no significant difference between salvage
and non-salvage APR (p = 0.928).
Conclusion
Survival outcomes following salvage APR for persistent disease were significantly
worse than that for recurrent disease. Salvage APR did not improve survival outcomes
for persistent disease compared to non-salvage APR. These results will elicit a review
of persistent disease treatment strategies.
Keywords
Abbreviations:
SCCA (squamous cell carcinoma of the anus), APR (abdominoperineal resection), OS (overall survival), CRT (chemoradiotherapy), ACT II (randomized UKCCCR Anal Cancer Trial), CR (complete response), QoL (quality of life), JSCCR (Japanese Society for Cancer of the Colon and Rectum), RFS (relapse-free survival), HIV (human immunodeficiency virus), CI (confidence intervals), MST (median survival time)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 03, 2023
Accepted:
May 3,
2023
Received in revised form:
April 3,
2023
Received:
November 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
