肛管癌的疗效和预后因素分析

目的 回顾分析原发性肛管癌患者的疗效和预后因素。方法 2000—2011年本中心经治肛管癌患者3l例,鳞癌23例、腺癌8例。Ⅰ~Ⅲ期患者首程采用放疗为主治疗16例、手术为主治疗11例、化疗3例。结果 随访率为90%,随访时间满3年的样本数21例。全组3年总生存(OS)率和无进展生存(PFS)率分别为76%、56%。单因素分析显示临床分期和T分期为OS预后因素(χ²=12.11,P=0.001和χ²=4.64,P=0.031),并与PFS有相关趋势(χ²=2.91,P=0.088和χ²=2.75,P=0.097)。Ⅰ~Ⅲ期鳞癌患者首程放疗为主与手术为主治疗的3年OS率和PFS率均相似(80%与80%,χ²=0.08,P=0.776和78%与67%,χ²=0.17,P=0.697)。放疗患者3级皮肤或黏膜急性不良反应为37%,晚期肛门感觉或功能异常为9%。结论 临床分期、T分期是影响肛管癌患者预后的最主要因素,同期放化疗应作为肛管鳞癌患者根治性治疗手段的首选疗法,应用调强放疗技术有利于患者按计划完成放疗并避免发生严重不良反应。

Treatment outcome and prognostic factors in patients with carcinoma of the anal canal

Objective To retrospectively analyze the treatment outcome and prognostic factors in patients with primary carcinoma of the anal canal (CAC). Methods From January 2000 to December 2011, 31 patients with CAC were treated in our institution;of the 31 patients, 23 had squamous cell carcinoma, and 8 had adenocarcinoma. In the initial treatment for stage Ⅰ—Ⅲ patients, 16 were treated with radiotherapy-based modality, 11 with surgery-based modality, and 3 with chemotherapy. Results The follow-up rate was 90%;21 patients were followed up for at least 3 years. The 3-year overall survival (OS) rate and progression-free survival (PFS) rate were 76% and 56%, respectively. The univariate analysis showed that clinical stage and T stage were the prognostic factors for OS (χ²=12.11, P=0.001;χ²=4.64, P=0.031) and marginal prognostic factors for PFS (χ²=2.91, P=0.088;χ²=2.75, P=0.097). There were no significant differences in 3-year OS and PFS between the stage Ⅰ—Ⅲ patients with squamous cell carcinoma who received radiotherapy-based initial treatment and those who received surgery-based initial treatment (80% vs. 80%,χ²=0.08, P=0.776;78% vs. 67%,χ²=0.17, P=0.697). Of the patients treated with radiotherapy, 37% experienced grade 3 acute skin or mucosal toxicity, and 9% experienced impaired anal sensation or function as late toxicity. Conclusions Clinical stage and T stage are the most important prognostic factors in patients with CAC. Concurrent chemoradiotherapy should be the standard radical treatment for squamous cell carcinoma of the anal canal, and using intensity-modulated radiotherapy helps patients to complete the planned course of radiotherapy without severe adverse events.