| Prognostic Significance of Bulky Nodal Disease in Anal Cancer Management: A Multi Institutional Study |
Seok-Joo Chun1,2
, Eunji Kim3
, Won Il Jang4, Mi-Sook Kim4, Hyun-Cheol Kang1, Byoung Hyuck Kim1,3
, Eui Kyu Chie1,5
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1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
2Department of Radiation Oncology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
3Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
4Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
5Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
*Part of the manuscript in abstract form was presented at the 2024 ASCO Gastrointestinal Cancers Symposium (J Clin Oncol 2024;42(3 Suppl):abstr 1). License agreement for not-for-profit publication was made between Professor Eui Kyu Chie, MD, PhD, the corresponding author, and Wolters Kluwer Health Inc., the publisher of the Journal of Clinical Oncology.
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Received: March 13, 2024; Accepted: April 9, 2024. Published online: April 11, 2024.
*Seok-Joo Chun and Eunji Kim contributed equally to this work. |
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| ABSTRACT |
Purpose
This study aimed to assess the prognostic significance of bulky nodal involvement in patients with anal squamous cell carcinoma treated with definitive chemoradiotherapy.
Materials and Methods
We retrospectively analyzed medical records of patients diagnosed with anal squamous cell carcinoma who underwent definitive chemoradiotherapy at three medical centers between 2004 and 2021. Exclusion criteria included distant metastasis at diagnosis, 2D radiotherapy, and salvage treatment for local relapse. Bulky N+ was defined as nodes with a long diameter of 2 cm or greater.
Results
A total of 104 patients were included, comprising 51 with N0, 46 with non-bulky N+, and 7 with bulky N+. The median follow-up duration was 54.0 months (range, 6.4-162.2 months). Estimated 5-year progression-free survival (PFS), loco-regional recurrence-free survival (LRRFS), and overall survival (OS) rates for patients with bulky N+ were 42.9%, 42.9%, and 47.6%, respectively. Bulky N+ was significantly associated with inferior PFS, LRRFS and OS compared to patients without or with non-bulky N+, even after multivariate analysis. We proposed a new staging system incorporating bulky N+ as N2 stage, with estimated 5-year LRRFS, PFS, and OS rates of 81.1%, 80.6%, and 86.2% for stage I, 67.7%, 60.9%, and 93.3% for stage II, and 42.9%, 42.9%, and 47.6% for stage III disease, enhancing the predictability of prognosis.
Conclusion
Patients with bulky nodal disease treated with standard chemoradiotherapy experienced poor survival outcomes, indicating the potential necessity for further treatment intensification. |
| Key words:
Anus neoplasms, Bulky nodes, Chemoradiotherapy |
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