Abstract
In squamous cell anal canal neoplasms, persistent disease or recurrence after initial
chemoradiotherapy are not the rule, yet their occurrence deserves to be analyzed to
better identify prognostics factors. The aim of our study was to describe the patterns
of failures of the initial treatment, their subsequent evolution and to identify prognostic
factors in these relapsed patients.
All patients with non-metastatic anal squamous cell carcinoma initially treated with
curative intent at the Centre Antoine Lacassagne between 1999 and 2019, and who presented
persistent disease or recurrence were analyzed. The median follow-up was 44 months.
Univariate and multivariate analyses were performed to identify prognostic factors.
From our database of 528 patients, 77 patients were eligible: 25 with persistent disease
and 52 with recurrence after complete response. The median overall survival was 39
months (95% CI: 25.5–52.3 months) from the date of treatment failure. In univariate
analysis, prognostic factors were gender, initial lymph node status, type of failure,
response to treatment's failure. In multivariate analysis, only female gender remained
statistically significant (HR 0.43- P=0.016). 32% of patients with persistent disease had metastatic status. 17.3% and
5.8% of recurrences respectively occurred after three and five years of follow-up.
Systematic imaging could be performed after initial treatment because of distant lesions
in one third of patients with persistent disease. The follow-up should not be interrupted
before five years, given the significant frequency of late recurrences. In multivariate
analysis, only female gender was statistically significant. Stratified treatment based
on prognostic factors could be envisaged, the details of which remain to be defined.
Keywords
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Article info
Publication history
Published online: July 08, 2022
Accepted:
July 3,
2022
Received in revised form:
March 14,
2022
Received:
October 24,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
