Multicenter Study

. 2022 Jul;11(14):2735-2743.

doi: 10.1002/cam4.4631. Epub 2022 Mar 10.

Characteristics of anal canal cancer in Japan

Kazutaka Yamada¹, Yasumitsu Saiki¹, Koji Komori², Akio Shiomi³, Masashi Ueno⁴, Masaaki Ito⁵, Koya Hida⁶, Seiichiro Yamamoto⁷, Manabu Shiozawa⁸, Soichiro Ishihara⁹, Yukihide Kanemitsu¹⁰, Hideki Ueno¹¹, Tatsuya Kinjo¹², Kotaro Maeda¹³, Junichiro Kawamura¹⁴, Fumihiko Fujita¹⁵, Keiichi Takahashi¹⁶, Tsunekazu Mizushima¹⁷, Yasuhiro Shimada¹⁸, Shin Sasaki¹⁹, Eiji Sunami²⁰, Fumio Ishida²¹, Keiji Hirata²², Shinobu Ohnuma²³, Kimihiko Funahashi²⁴, Jun Watanabe²⁵, Yusuke Kinugasa²⁶, Shigeki Yamaguchi²⁷, Yojiro Hashiguchi²⁸, Masataka Ikeda²⁹, Takeshi Sudo³⁰, Yoshito Komatsu³¹, Keiji Koda³², Kazuhiro Sakamoto³³, Masazumi Okajima³⁴, Hideyuki Ishida³⁵, Yuichi Hisamatsu³⁶, Taiki Masuda³⁷, Shinichiro Mori³⁸, Kazuhito Minami³⁹, Seiji Hasegawa⁴⁰, Shungo Endo⁴¹, Akinori Iwashita⁴², Madoka Hamada⁴³, Yoichi Ajioka⁴⁴, Koichiro Usuku⁴⁵, Tokunori Ikeda⁴⁵, Kenichi Sugihara⁴⁶

Affiliations

¹ Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan.
² Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
³ Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
⁴ Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
⁶ Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
⁷ Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan.
⁸ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁹ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
¹⁰ Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
¹¹ Department of Surgery, National Defense Medical College, Saitama, Japan.
¹² Department of Digestive and General Surgery, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan.
¹³ International Medical Center, Fujita Health University Hospital, Aichi, Japan.
¹⁴ Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
¹⁵ Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
¹⁶ Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
¹⁷ Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁸ Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan.
¹⁹ Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
²⁰ Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.
²¹ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
²² Department of Surgery1, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
²³ Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan.
²⁴ Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan.
²⁵ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
²⁶ Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²⁷ Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
²⁸ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
²⁹ Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
³⁰ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
³¹ Department of Cancer Center, Hokkaido University Hospital, Hokkaido, Japan.
³² Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
³³ Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
³⁴ Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
³⁵ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
³⁶ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³⁷ Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
³⁸ Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan.
³⁹ Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
⁴⁰ Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan.
⁴¹ Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.
⁴² Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁴³ Division of Gastrointestinal Surgery, Kansai Medical University Hospital, Osaka, Japan.
⁴⁴ Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
⁴⁵ Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan.
⁴⁶ Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 35274487
PMCID: PMC9302302
DOI: 10.1002/cam4.4631

Multicenter Study

Characteristics of anal canal cancer in Japan

Kazutaka Yamada et al. Cancer Med. 2022 Jul.

. 2022 Jul;11(14):2735-2743.

doi: 10.1002/cam4.4631. Epub 2022 Mar 10.

Authors

Affiliations

¹ Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan.
² Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
³ Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
⁴ Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
⁶ Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
⁷ Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan.
⁸ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁹ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
¹⁰ Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
¹¹ Department of Surgery, National Defense Medical College, Saitama, Japan.
¹² Department of Digestive and General Surgery, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan.
¹³ International Medical Center, Fujita Health University Hospital, Aichi, Japan.
¹⁴ Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
¹⁵ Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
¹⁶ Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
¹⁷ Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁸ Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan.
¹⁹ Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
²⁰ Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.
²¹ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
²² Department of Surgery1, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
²³ Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan.
²⁴ Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan.
²⁵ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
²⁶ Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²⁷ Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
²⁸ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
²⁹ Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
³⁰ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
³¹ Department of Cancer Center, Hokkaido University Hospital, Hokkaido, Japan.
³² Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
³³ Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
³⁴ Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
³⁵ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
³⁶ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³⁷ Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
³⁸ Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan.
³⁹ Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
⁴⁰ Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan.
⁴¹ Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.
⁴² Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁴³ Division of Gastrointestinal Surgery, Kansai Medical University Hospital, Osaka, Japan.
⁴⁴ Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
⁴⁵ Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan.
⁴⁶ Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 35274487
PMCID: PMC9302302
DOI: 10.1002/cam4.4631

Abstract

Anal canal cancer (ACC) has been reported to be an uncommon cancer in Japan, as in the USA, Europe, and Australia. This retrospective multi-institutional study was conducted to clarify the characteristics of ACC in Japan. First, the histological ACC type cases treated between 1991 and 2015 were collected. A detailed analysis of the characteristics of anal canal squamous cell carcinoma (SCC) cases was then conducted. The results of the histological types revealed that of the 1781 ACC cases, 435 cases (24.4%) including seven cases of adenosquamous cell carcinomas were SCC and 1260 cases (70.7%) were adenocarcinoma. However, the most common histological type reported in the USA, Europe, and Australia is SCC. Most ACC cases are adenocarcinomas and there is a low incidence of SCC in Japan which is different from the above-mentioned countries. Moreover, we reclassified T4 into the following two groups based on tumor size: T4a (tumor diameter of 5 cm or less) and T4b (tumor diameter of more than 5 cm). The results of the TNM classification of SCC revealed that the hazard ratio (HR) to T1 of T2, T3, T4a, and T4b was 2.45, 2.28, 2.89, and 4.97, respectively. As T4b cases had a worse prognosis than T4a cases, we propose that T4 for anal canal SCC in Japan be subclassified into T4a and T4b.

Keywords: abdominoperineal resection; anal canal cancer; chemoradiotherapy; human papillomavirus; squamous cell carcinoma.

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Conflict of interest statement

Kazutaka Yamada and the co‐authors have no conflicts of interest to declare.

Figures

**FIGURE 1**
Overall survival rates and hazard ratios for each T factor case of anal canal squamous cell carcinoma, comparing the prognosis of T4a and T4b cases. Abbreviation: CI, confidence interval. T4a; T4 ≤5 cm, T4b; T4 >5 cm

**FIGURE 2**
Treatment results based on the TNM classification (8th edition). Abbreviation: CI, confidence interval

**FIGURE 3**
Review of the staging classification of anal canal squamous cell carcinoma incorporating the T4 subclassification. Abbreviation: CI, confidence interval. T4a; T4 ≤5 cm, T4b; T4 >5 cm

See this image and copyright information in PMC

References

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1. International Agency for Research on Cancer. Global Cancer Observatory Cancer today. https://gco.iarc.fr/today/fact‐sheets‐populations. Accessed December 3, 2021.
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Characteristics of anal canal cancer in Japan

Affiliations

Characteristics of anal canal cancer in Japan

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Supplementary concepts

LinkOut - more resources

Full Text Sources

Medical

Research Materials