740P - Prognostic factors for local recurrence, distant metastases and survival in anal carcinoma

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anal Cancer
Presenter Zainul Abedin Kapacee
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors Z.A. Kapacee1, S. Susnerwala2, N. Scott3, F.D. Danwata4, M. Wise2, A. Biswas2
  • 1Manchester Medical School, University of Manchesrer, M13 9PT - Manchester/GB
  • 2Rosemere Cancer Centre, Royal Preston Hospital, Lancashire Teaching Hospitals Trust, PR2 9HT - Preston/GB
  • 3Royal Preston Hospital, Lancashire Teaching Hospitals Trust, PR2 9HT - Preston/GB
  • 4Rosemere Centre, Royal Preston Hospital-Lancashire Teaching Hospitals NHS Foundation Trust, PR2 9HT - Preston/GB

Abstract

Aim

Recent literature has sought prognostic factors for survival outcomes in anal cancer patients. Similarly, our study aims to determine prognostic factors for local disease recurrence, distant metastases and survival from patients treated with standardized radical chemo-radiotherapy at the Rosemere Cancer Centre, Lancashire, UK.

Methods

Patients treated with radical concurrent chemoradiation for non-metastatic squamous cell anal cancer from September 2000 to January 2013 were retrospectively studied. Kaplan-Meier and Cox Regression proportional hazards methods were used to assess prognostic value of age, sex, tumour size, anal canal circumference involved (ACCI), nodal disease, tumour location and pre-treatment haemoglobin.

Results

A total of 148 patients (95 females, 53 males) with a mean age of 63 were studied. From the sample population 15% of patients suffered local disease recurrence and 10% developed distant metastases. The estimated five-year overall survival and cancer specific survival was 84% and 86% respectively. Predictors of local recurrence were tumour size greater than 5cm and over two-thirds ACCI (p < 0.01). Predictors of distant metastases and poor cancer survival were: tumour size greater than 5cm (p < 0.01), node positive disease on imaging (p < 0.05), over two-thirds ACCI (p < 0.01) and pre-treatment haemoglobin below 130g/l (p < 0.05). Multivariate analysis found tumour size greater than 5cm most significant for local recurrence [HR 4.20, 95% Confidence Interval (C.I) 1.73-12.11; p = 0.002] and survival [HR: 2.686; 95% CI 1.18-6.13; p = 0.02] whilst over two-thirds ACCI was most predictive of distant metastases [HR 8.47; 95% C.I 3.03-23.64; p < 0.001]. Age, sex, palpable lymph nodes and tumour location within the anal canal failed to show statistical significance as prognostic factors for local disease recurrence, distant metastases or cancer survival.

Conclusions

Tumour size, nodal disease, over two thirds ACCI and low pre-treatment haemoglobin confer poorer prognostic and survival outcomes. Future use of intensity modulated radiation therapy (IMRT) can decrease patient morbidity, which may allow increase of radiation doses for locally advanced anal cancers and thus improve local control and survival outcomes.

Disclosure

All authors have declared no conflicts of interest.