Squamous cell carcinoma of the rectum: Practice trends and patient survival

Abstract

PurposeLeverage the National Cancer Database (NCDB) to evaluate trends in management of nonmetastatic squamous cell cancer (SCC) of the rectum and their effect on survival for this uncommon tumor.Methods and MaterialsRetrospective data was obtained from the NCDB for patients diagnosed with SCC of the rectum between 2004 and 2014, including cT1‐4, cN0‐2, cM0 tumors (cohort A, n = 2296). A subgroup analysis was performed on locally advanced tumors (cT1‐T2, N+ or cT3, N any, subcohort B, n = 883), treated with chemoradiation (n = 706) or trimodality therapy (n = 177) including chemotherapy, radiation, and surgery. Pathological complete response rate following neoadjuvant therapy was obtained. Univariate and multivariate logistic regression analyses were performed to generate hazard ratios (HR) investigating factors associated with overall survival. Kaplan‐Meier (K‐M) method was used to estimate overall surviving proportion at 5 and 10 years.ResultsThe K‐M estimated 5 and 10 year overall survival for stage I disease was 71.3% and 57.8%, respectively; stage II disease was 57.0% and 38.9%, respectively; stage III disease was 57.8% and 41.5%, respectively. On multivariate analysis, higher cT category (P < 0.001) resulted in worse survival. For locally advanced tumors (subcohort B), there was no significant difference in survival between chemoradiation alone compared to trimodality therapy (P = 0.909 on multivariate analysis).ConclusionsMost providers manage locally advanced SCC of the rectum similar to anal cancer, which results in equivalent overall survival and spares patients from the additional morbidity associated with surgical resection.

Case Report: Management of rectal squamous cell carcinoma - a treatment dilemma

“…Some of the most prominent risk factors include tobacco use, inflammatory bowel disease, radiotherapy and infections such as human immunodeficiency virus, human papilloma virus, amebiasis, and schistosomiasis 4 , 5 . Compared to adenocarcinoma of the rectum, RSCC occurs more often in younger Caucasian women with an average age of 60 years 6 , 7 . Patients clinically present with one or more of the following: gastrointestinal bleeding, changes in stool shape, diarrhea, constipation, tenesmus, weight loss and lower abdominal pain 5 .…”

“…Historically, radical surgery was recommended for RSCC. However, more recent analyses have shown improved outcomes following chemoradiation only in localized disease or preceding salvage surgical resection in advanced disease to reduce tumor burden 2 – 4 , 6 , 7 , 10 . One of the main factors contributing to the discrepancy among the results and conclusions drawn is the lack of consistency in staging criteria used among all studies.…”

Squamous rectal carcinoma: a rare malignancy, literature review and management recommendations

“… 26 showed that adding surgery after concomitant CRT (trimodality treatment) did not impact OS compared with CRT alone ( P = 0.909 on multivariate analysis) supporting the effectiveness of CRT alone, without surgery. 26 This is consistent with a prior report by Kulaylat et al. 3 who showed that performing salvage surgery (i.e.…”

“…Finally, in a large retrospective analysis (data from the National Cancer Database) with 2296 rSCC patients, Dutta et al. 26 showed that adding surgery after concomitant CRT (trimodality treatment) did not impact OS compared with CRT alone ( P = 0.909 on multivariate analysis) supporting the effectiveness of CRT alone, without surgery. 26 This is consistent with a prior report by Kulaylat et al.…”

“…Chiu et al., 2 in their population-based analysis (SEER, 1998-2011) with rSCC patients, showed that favourable prognostic factors included: receipt of radiotherapy, local stage, younger age, female sex and white race. In a retrospective analysis by Dutta et al., 26 worse OS was associated with age (>65 years old), male sex, African/American race, higher Charlson comorbidity index (CCI) score, and a lower median income. In this study, tumour grade did not influence survival.…”