Background and Aims: Development of squamous cell cancer of the anus is associated with multiple risk factors including infection with human papilloma virus, immunosuppression, chronic inflammation, and tobacco smoking, although there is little data on these factors for recurrent disease. Primary treatment for anal cancer is chemoradiation, with surgery reserved for incomplete response to treatment and/or recurrence, which may occur in 30-40% of patients. Here, we evaluated the risk of recurrence and mortality of anal carcinoma in association with tobacco smoking.
Methods: Following IRB approval, we conducted a retrospective review of cases of anal carcinoma from two local hospitals, and obtained information on treatment response and cancer recurrence, as well as tobacco usage from pathology and medical records.
Results: We identified 80 patients with anal carcinoma, with 39 (49%) having a tobacco smoking history. Of these 39, 24 (62%) were smoking during their chemoradiation treatment for anal carcinoma. Comparing current tobacco smokers to former smokers, smokers had higher carcinoma recurrence rates (9/24, 38% vs 2/15, 13%) and mortality (6/24, 25% vs 0/15, 0%) from anal carcinoma. All mortality cases were associated with recurrence of anal carcinoma.
Conclusion: Tabacco smoking is a risk factor for the development of anal carcinoma, and appears to be associated with recurrence of the disease, leading to increased mortality. This data suggests that patients should be cautioned about continued tobacco smoking after a diagnosis of anal carcinoma in attempt to improve their outcome.