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TRENDS IN EARLY-STAGE ANAL CANCER TREATMENT FROM THE NATIONAL CANCER DATABASE
Cynthia Araradian
*, Sandy Fang
Department of Surgery, Oregon Health & Science University, Portland, OR
Background: The incidence of anal cancer has been increasing by 2.7%/year over the last decade. The most common type of anal cancer is squamous cell cancer and is associated with the human papilloma virus (HPV). Prior to the 1970s, the mainstay of treatment for anal squamous cell cancer (ASCC) was abdominoperineal resection (APR). The introduction of the Nigro protocol (a combination of 5-fluorouracil, mitomycin C, and radiation), has yielded complete oncologic response rates of 70-80%; no longer necessitating the need for APR. The treatment for early-stage anal cancers, node-negative T1 and T2 cancers, remains controversial. Local excision of early anal cancers is a favorable option for these patients to avoid the adverse effects of chemoradiation or permanent colostomy via APR.
Methods: The National Cancer Database (NCDB) was queried from 2004-2021 for all patients ages >18-90+ years with anal cancer. Patients with node negative, early anal cancer (T1 and T2 cancers) were included in the study. We aimed to evaluate the trends in management, including surgery, chemoradiation and systemic therapy, of early anal cancer from 2004-2012 and 2013-2021.
Results: 31,514 node-negative patients with T1 and T2 anal cancers were identified in NCDB. Patients were more commonly female 21,016 (66.7%) and white 27,806 (88.2%). The average age of patients was 62.3 (12.9). T2 cancers were more common with 19,947 (63.3%) of the patients diagnosed with clinical T2 and 11,567 (36.7%) with T1 cancer (Table 1). Regarding treatment for early anal cancers, patients received chemotherapy, radiation, surgery, and immunotherapy, or a combination for treatment. Overall, 25,547 (81.1%) patients received radiation with 10,495 (80.8%) patients receiving radiation in the years 2004-2012 and 15,052 (81.2%) from 2013-2021 (p=0.32). For T1 cancers, from 2004-2012 3,485 (69.5%) patients underwent radiation and from 2013-2021 4,510 (68.8%) patients (p=0.39). For T2 cancers, from 2004-2012 7,010 (87.9%) patients underwent radiation and from 2013-2021 10,542 (88.1%) patients (p=0.71). The most common operation was a local excision with 4,796 (36.93%) patients in 2004-2012 and 6,095 (32.90%) in 2013-2021 (p<0.01). For T1 cancers, the local excisions performed from 2004-2012 were 2,735 (54.6%) and from 2013-2021 were 3,371 (51.4%) (p <0.01). For T2 cancers, the local excisions performed from 2004-2012 were 2,061 (25.8%) and from 2013-2021 were 2,718 (22.7%) (p <0.01) (Table 2).
Conclusion: Overall, there has been a decrease in the number of local excisions performed for both T1 and T2 cancers, but no change in radiation treatment for early anal cancer treatment. With local excisions, it is difficult to ascertain if the intent of surgery was curative or if it was meant to be used for diagnostic purposes with chemoradiation used for curative intent.
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