Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Abstract

Background: Literature pertaining to prophylactic inguinal nodal treatment for anal adenocarcinoma in China is scarce.Methods: In this retrospective study, we analyzed 126 patients from 1965 to 2015. Among these, 67 patients received surgery only, 18 patients received chemoradiotherapy only, 27 patients received a combination of both, and the remaining 14 patients received palliative treatment.Results: The median follow up period was 30 months. The 1-year, 3-year, and 5-year overall survival rates were 85.8%, 62.5%, and 43.4%, respectively. The 5-year overall survival was 46.9% for patients with negative inguinal lymph nodes and 19.1% for patients with positive inguinal lymph nodes (p=0.007). The overall 5-year inguinal node relapse-free survival was 83.0%. The 5-year inguinal node relapse-free survival was 87.5% for stage I, 86.9% for stage II, and 76.5% for stage III cancers. Among those with negative inguinal nodes, the 5-year inguinal node relapse-free survival was 85.7% for negative regional lymph nodes and 75.4% for positive regional lymph nodes (p=0.089).Conclusion: Inguinal lymph node is a high-risk subclinical area. Prophylactic inguinal nodal treatment is necessary for patients with anal adenocarcinoma irrespective of positive or negative inguinal lymph nodes.

Long-term outcomes after surgical dissection of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma

“…The present study found that, for long-term outcomes after inguinal LN dissection from rectal or anal canal adenocarcinoma with curative intent, MST was 66.6 months and 5-year OS was 55.2%. These results are noticeably better than previous data reported for inguinal LN metastasis from anal canal or rectal adenocarcinoma (MST, 8–14.8 months; 5-year OS, 0–19.1%) [8, 9, 11, 20]. This discrepancy could be due to the small sample size in the previous studies (8–32 patients) [8, 9, 11, 20], as well as recent developments in chemotherapy and the multidisciplinary team approach.…”

“…These results are noticeably better than previous data reported for inguinal LN metastasis from anal canal or rectal adenocarcinoma (MST, 8–14.8 months; 5-year OS, 0–19.1%) [8, 9, 11, 20]. This discrepancy could be due to the small sample size in the previous studies (8–32 patients) [8, 9, 11, 20], as well as recent developments in chemotherapy and the multidisciplinary team approach. In our study, although almost 80% of patients experienced recurrence after inguinal LN dissection, a multidisciplinary team approach that included surgical treatment and chemotherapy for recurrent tumors could have led to the better prognosis.…”

“…In contrast, adenocarcinoma is the predominant histological subtype of malignancy arising in the anal canal in Asian countries such as Japan and China [7]. Specifically, adenocarcinomas account for 63% of anal canal cancers in China [8] and 74% in Japan [7], although anal canal cancer itself is a rare disease in these countries. Given the rarity of this disease, little is known about the long-term outcomes of inguinal LN metastasis from anal canal adenocarcinoma.…”

“…Given the rarity of this disease, little is known about the long-term outcomes of inguinal LN metastasis from anal canal adenocarcinoma. The largest study cohort of patients (21 patients) with inguinal LN metastasis from anal canal adenocarcinoma to date was reported by Su et al, showing 5-year overall survival (OS) rate as 19.1% [8].…”

What factors are associated with the poor prognosis of anal adenocarcinoma compared with low-lying rectal adenocarcinoma based on a population analysis: A propensity score matching study

“…Anal adenocarcinoma (AA), which is thought to originate from the columnar epithelium lining the anal glands, is a rare condition, accounting for approximately 1.5%-2.5% of all digestive system cancers[1, 2]. However, the worldwide incidence rate has steadily increased over the years[2]. The anatomical terminology and pathogenesis of this disease are controversial, leading to disparities in both diagnosis and treatment[3].…”