Oncologic outcomes of salvage abdominoperineal resection for anal squamous cell carcinoma initially managed with chemoradiation Journal Article

   

Authors:	Rosen, R.; Quezada-Diaz, F. F.; Gönen, M.; Karagkounis, G.; Widmar, M.; Wei, I. H.; Smith, J. J.; Nash, G. M.; Weiser, M. R.; Paty, P. B.; Cercek, A.; Romesser, P. B.; Sanchez-Vega, F.; Adileh, M.; Roth O'Brien, D.; Hajj, C.; Williams, V. M.; Shcherba, M.; Gu, P.; Crane, C.; Saltz, L. B.; Garcia Aguilar, J.; Pappou, E.
Article Title:	Oncologic outcomes of salvage abdominoperineal resection for anal squamous cell carcinoma initially managed with chemoradiation
Abstract:	Background: Abdominoperineal resection (APR) has been advocated for persistent or recurrent disease after failure of chemoradiation (CRT) for anal squamous cell cancer (SCC). Treatment with salvage APR can potentially achieve a cure. This study aimed to analyze oncological outcomes for salvage APR in a recent time period at a comprehensive cancer center. Methods: A retrospective review of all patients who underwent APR for biopsy-proven persistent or recurrent anal SCC between 1 January 2007 and 31 December 2020 was performed. Patients with stage IV disease at the time of initial diagnosis and patients with missing data were excluded. Univariate analysis was used with a chi-square test for categorical variables, and non-parametric tests were used for continuous variables. Kaplan–Meier survival analysis was performed to evaluate disease-specific (DSS), post-APR local recurrence-free (RFS), and disease-free survival (DFS). Results: A total of 96 patients were included in the analysis: 39 (41%) with persistent disease and 57 (59%) with recurrent SCC after chemoradiation had been completed. The median follow-up was 22 months (IQR 11–47). Forty-nine patients (51%) underwent extended APR and/or pelvic exenteration. Eight (8%) patients developed local recurrence, 30 (31%) developed local and distant recurrences, and 16 (17%) developed distant recurrences alone. The 3-year DSS, post-APR local recurrence-free survival, and disease-free survival were 53.8% (95% CI 43.5–66.5%), 54.5% (95% CI 44.4–66.8%), and 26.8% (95% CI 18.6–38.7%), respectively. In multivariate logistic regression analysis, positive microscopic margin (OR 10.0, 95% CI 2.16–46.12, p = 0.003), positive nodes in the surgical specimen (OR 9.19, 95% CI 1.99–42.52, p = 0.005), and lymphovascular invasion (OR 2.61 95% CI 1.05–6.51, p = 0.04) were associated with recurrence of disease. Gender, indication for APR (recurrent vs. persistent disease), HIV status, extent of surgery, or type of reconstruction did not influence survival outcomes. Twenty patients had targeted tumor-sequencing data available. Nine patients had PIK3CA mutations, seven of whom experienced a recurrence. Conclusions: Salvage APR for anal SCC after failed CRT was associated with poor disease-specific survival and low recurrence-free survival. Anal SCC patients undergoing salvage APR should be counseled that microscopic positive margins, positive lymph nodes, or the presence of lymphovascular invasion in the APR specimen are prognosticators for disease relapse. Our results accentuate the necessity for additional treatment strategies for the ongoing treatment challenge of persistent or recurrent anal SCC after failed CRT. © 2024 by the authors.
Keywords:	adult; controlled study; human tissue; treatment outcome; aged; survival analysis; major clinical study; cancer recurrence; squamous cell carcinoma; cisplatin; fluorouracil; multimodality cancer therapy; patient selection; capecitabine; follow up; cohort analysis; retrospective study; pelvis exenteration; mitomycin; wound closure; chemoradiotherapy; chi square distribution; recurrence free survival; rectum abdominoperineal resection; combined modality treatment; anal cancer; local recurrence free survival; lymph vessel metastasis; human; male; female; article; anal squamous cell carcinoma; salvage apr
Journal Title:	Journal of Clinical Medicine
Volume:	13
Issue:	8
ISSN:	2077-0383
Publisher:	MDPI
Date Published:	2024-04-02
Start Page:	2156
Language:	English
DOI:	10.3390/jcm13082156
PROVIDER:	scopus
PMCID:	PMC11050212
PUBMED:	38673429
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85191350600&doi=10.3390%2fjcm13082156&partnerID=40&md5=895909a252a0751690237790046c4e56
Notes:	Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Emmanouil Pappou -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/216250