Cancer Res Treat.  2024 Oct;56(4):1197-1206. 10.4143/crt.2024.258.

Prognostic Significance of Bulky Nodal Disease in Anal Cancer Management: A Multi-institutional Study

• Chun SJ
• Kim E
• Jang WI
• Kim MS
• Kang HC
• Kim BH
• Chie EK

• KMID: 2560253
• DOI: http://doi.org/10.4143/crt.2024.258

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 seven with bulky N+. The median follow-up duration was 54.0 months (range, 6.4 to 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 category, 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.

Keyword

Anus neoplasms; Bulky nodes; Chemoradiotherapy

Figure

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  Fig. 1. Loco-regional recurrence-free survival (A), progression-free survival (B), and overall survival (C) of patients with N0, non-bulky N+, and bulky N+.

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  Fig. 2. Loco-regional recurrence-free survival (A), progression-free survival (B), and overall survival (C) of patients according to newly suggested stage.

Reference

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