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. 2022 Feb;13(1):185-196.
doi: 10.21037/jgo-21-482.

Long term clinical outcomes and associated predictors of progression free survival in anal canal cancer

Sara E Beltrán Ponce  1 , Beth A Erickson  1 , William A Hall  1 , Meena Bedi  1 , Michael J Martens  2 , Malika Siker  1 , James Thomas  3 , Ben George  3 , Kirk Ludwig  4 , Carrie Peterson  4 , Timothy Ridolfi  4 , John M Longo  1
Affiliations

Long term clinical outcomes and associated predictors of progression free survival in anal canal cancer

Sara E Beltrán Ponce et al. J Gastrointest Oncol. 2022 Feb.

Abstract

Background: Reports of long term clinical outcomes for patients with squamous cell carcinoma (SCC) of the anal canal treated with chemotherapy and intensity modulated radiation therapy (IMRT) are limited. Pre-treatment hematologic variables associated with outcomes remain understudied. We sought to report the long-term clinical outcomes of a cohort of patients treated with definitive chemoradiation (CRT) utilizing helical tomotherapy (HT) IMRT at a single tertiary referral center. We further sought to examine for any correlations between pre-treatment hematologic parameters and progression free survival (PFS).

Methods: Data from patients with SCC of the anal canal treated with definitive CRT using HT IMRT from 2005 to 2017 were collected. Pre-treatment patient characteristics examined for correlations with PFS included: hemoglobin (Hgb) level, age, diabetes mellitus (DM) status, smoking status, neutropenia, thrombocytopenia, leukopenia, neutrophil/lymphocyte ratio, neutrophil/WBC ratio, lymphocyte/WBC ratio, sex, transplant status, HIV status, Karnofsky performance score, T-stage, and N-stage. Pre-treatment Hgb levels were recorded within two weeks prior to starting CRT. Clinical outcomes, including PFS, were described using the Kaplan-Meier estimator. A multivariable (MVA) Cox model of PFS evaluated the impact of pre-treatment Hgb and diabetes while adjusting for T-stage and age.

Results: The median patient age was 57 years old (range, 26-87) and there were 39 females (63.9%) with the remaining patients identifying as males. Median patient follow up was 5.8 years. The PFS was 83% at 5 years. The median pre-treatment Hgb was 13 g/dL. On multivariable analysis (MVA), Hgb ≤10 g/dL (HR: 11.891, 95% CI: 2.649-53.391, P=0.001) and a diagnosis of diabetes mellitus (HR: 4.524, 95% CI: 1.436-14.252, P=0.010) were both significantly associated with a worse PFS. These factors were independent of T-stage and age.

Conclusions: Long-term clinical outcomes for patients with SCC of the anal canal treated with definitive CRT are presented. Pre-treatment hemoglobin of ≤10 g/dL and diabetes were both independently associated with worse PFS on MVA. This retrospective data supports further prospective study of the impact of hematologic markers and medical co-morbidities such as DM and their management on clinical outcomes for patients with SCC of the anal canal treated with curative-intent CRT.

Keywords: Chemoradiation; HPV-mediated cancers; anal canal carcinoma.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-21-482/coif). WAH has grant funding from the We Care Fund for Medical Innovation and Research, Elekta Instruments AB, Advancing Healthier Wisconsin Research and Education Program and is a Co-I on R01CA247960 and R01CA24988 funded grants. All funding is paid to the institution. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Estimated PFS curves by pre-treatment hemoglobin level stratified by less than or equal to (green) or greater than (orange) 10 for 10 years following completion of treatment. PFS, progression-free survival.
Figure 2
Figure 2
Estimated OS curves by pre-treatment hemoglobin level stratified by less than or equal to (green) or greater than (orange) 10 for 10 years following completion of treatment. OS, overall survival.
See this image and copyright information in PMC

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