TY - JOUR
T1 - Impact of surgical resection on survival outcomes after chemoradiotherapy in anal adenocarcinoma
AU - Li, Richard
AU - Shinde, Ashwin
AU - Fakih, Marwan
AU - Sentovich, Stephen
AU - Melstrom, Kurt
AU - Nelson, Rebecca
AU - Glaser, Scott
AU - Chen, Yi Jen
AU - Goodman, Karyn
AU - Amini, Arya
N1 - Publisher Copyright:
© 2019 Harborside Press. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Background: Anal adenocarcinoma is a rare malignancy with a poor prognosis, and no randomized data are available to guide management. Prior retrospective analyses offer differing conclusions on the benefit of surgical resection after chemoradiotherapy (CRT) in these patients. We used the National Cancer Database (NCDB) to analyze survival outcomes in patients undergoing CRT with and without subsequent surgical resection. Methods: Patients with adenocarcinoma of the anus diagnosed in 2004 through 2015 were identified using the NCDB. Patients with metastatic disease and survival,90 days were excluded.We analyzed patients receiving CRT and stratified by receipt of surgical resection. Logistic regression was used to evaluate predictors of use of surgery and to form a propensity score-matched cohort. Overall survival (OS) was compared between treatment strategies using Cox proportional hazards regression. Results: We identified 1,747 patients with anal adenocarcinoma receiving CRT, of whom 1,005 (58%) received surgery. Predictors of increased receipt of surgery included age,65 years, private insurance, overlapping involvement of the anus and rectum, N0 disease, and external-beam radiation dose$4,000 cGy. With a median followup of 3.5 years, 5-year OS was 61.1% in patients receiving CRT plus surgery compared with 39.8% in patients receiving CRT alone (logrank P,.001). In multivariate analysis, surgery was associated with significantly improved OS (hazard ratio, 20.59; 95% CI, 0.50-0.68; P,.001). This survival benefit persisted in a propensity score-matched cohort (log-rank P,.001). Conclusions: In the largest series of anal adenocarcinoma cases to date, treatment with CRT followed by surgery was associated with a significant survival benefit compared with CRT alone in propensity score-matching analysis. Our findings support national guideline recommendations of neoadjuvant CRT followed by resection for patients with anal adenocarcinoma.
AB - Background: Anal adenocarcinoma is a rare malignancy with a poor prognosis, and no randomized data are available to guide management. Prior retrospective analyses offer differing conclusions on the benefit of surgical resection after chemoradiotherapy (CRT) in these patients. We used the National Cancer Database (NCDB) to analyze survival outcomes in patients undergoing CRT with and without subsequent surgical resection. Methods: Patients with adenocarcinoma of the anus diagnosed in 2004 through 2015 were identified using the NCDB. Patients with metastatic disease and survival,90 days were excluded.We analyzed patients receiving CRT and stratified by receipt of surgical resection. Logistic regression was used to evaluate predictors of use of surgery and to form a propensity score-matched cohort. Overall survival (OS) was compared between treatment strategies using Cox proportional hazards regression. Results: We identified 1,747 patients with anal adenocarcinoma receiving CRT, of whom 1,005 (58%) received surgery. Predictors of increased receipt of surgery included age,65 years, private insurance, overlapping involvement of the anus and rectum, N0 disease, and external-beam radiation dose$4,000 cGy. With a median followup of 3.5 years, 5-year OS was 61.1% in patients receiving CRT plus surgery compared with 39.8% in patients receiving CRT alone (logrank P,.001). In multivariate analysis, surgery was associated with significantly improved OS (hazard ratio, 20.59; 95% CI, 0.50-0.68; P,.001). This survival benefit persisted in a propensity score-matched cohort (log-rank P,.001). Conclusions: In the largest series of anal adenocarcinoma cases to date, treatment with CRT followed by surgery was associated with a significant survival benefit compared with CRT alone in propensity score-matching analysis. Our findings support national guideline recommendations of neoadjuvant CRT followed by resection for patients with anal adenocarcinoma.
UR - https://www.scopus.com/pages/publications/85072988843
U2 - 10.6004/jnccn.2019.7309
DO - 10.6004/jnccn.2019.7309
M3 - Article
C2 - 31590155
AN - SCOPUS:85072988843
SN - 1540-1405
VL - 17
SP - 1203
EP - 1210
JO - Journal of the National Comprehensive Cancer Network : JNCCN
JF - Journal of the National Comprehensive Cancer Network : JNCCN
IS - 10
ER -