Temporal improvements in loco-regional failure and survival in patients with anal cancer treated with chemo-radiotherapy: treatment cohort study (1990–2014)
Menée au Royaume-Uni à partir de données portant sur 560 patients atteints d'un carcinome épidermoïde de l'anus traité par chimioradiothérapie entre 1990 et 2014 (durée médiane de suivi : 61 mois), cette étude met en évidence sur cette période une réduction du taux d'échec locorégional et une amélioration des taux de survie, puis estime ces taux pour l'année 2020
Background : We evaluated oncological changes in patients with squamous cell carcinoma of the anus (SCCA) treated by chemoradiotherapy (CRT) from a large UK institute, to derive estimates of contemporary outcomes.
Methods : We performed a treatment-cohort analysis in 560 patients with non-metastatic SCCA treated with CRT over 25 years. The primary outcomes were 3-year loco-regional failure (LRF), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). We developed prediction models; and overlaid estimates on published results from historic trials.
Results : Age distributions, proportions by gender and cT stage remained stable over time. The median follow-up was 61 (IQR: 36–79) months. Comparing the first period (1990–1994) with the last period (2010–2014), 3-year LRF declined from 33 to 16% (Ptrends < 0.001); 5-year OS increased from 60% to 76% (Ptrends = 0.001); and 5-year CCS increased from 62% in to 80% (Ptrends = 0.001). For 2020, the models predicted a 3-year LRF of 14.7% (95% CIs: 0–31.3); 5-year OS of 74.7% (95% CIs: 54.6–94.9); and 5-year CSS of 85.7% (95% CIs: 75.3–96.0). Reported oncological outcomes from historic trials generally underestimated contemporary outcomes.
Conclusions : Current and predicted rates for 3-year LRF and 5-year survivals are considerably improved compared with those in historic trials.
British Journal of Cancer , résumé, 2020