Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2020; 12(7): 732-740
Published online Jul 15, 2020. doi: 10.4251/wjgo.v12.i7.732
Prognostic role of ultrasonography staging in patients with anal cancer
Paola De Nardi, Giaime G Arru, Giovanni Guarneri, Iliyan Vlasakov, Luca Massimino
Paola De Nardi, Giaime G Arru, Giovanni Guarneri, Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Iliyan Vlasakov, Vita-Salute University San Raffaele, Milan 20132, Italy
Luca Massimino, Laboratory of Immunopathology in Gastroenterology, Humanitas University, Pieve Emanuele, Milan 20132, Italy
Author contributions: De Nardi P designed the study, drafted the manuscript, participated in the acquisition, analysis, and interpretation of the data; Arru G, Guarneri G and Vlasakov I participated in the acquisition, analysis and interpretation of the data, revised the article critically for important intellectual content, and approved the final version; Massimino L participated in the analysis and interpretation of the data, revised the article critically for important intellectual content, provided the statistical analysis and approved the final version.
Institutional review board statement: No Institute review board approval is needed for retrospective observational studies.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paola De Nardi, MD, Doctor, Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy. denardi.paola@hsr.it
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: April 2, 2020
Revised: May 28, 2020
Accepted: June 14, 2020
Article in press: June 14, 2020
Published online: July 15, 2020
ARTICLE HIGHLIGHTS
Research background

The primary tumor staging of anal canal carcinomas is based on tumor dimension which is clinically and radiologically assessed. Novel tumor staging, based on depth of tumor invasion assessed by endorectal ultrasonography (US), have been proposed and have claimed to potentially affect initial treatment as well as prognosis.

Research motivation

Several authors reported that the staging based on tumor diameter is not an independent prognostic variable. If a different staging system could more accurately reflect the prognosis, it could be used not only to better predict outcome, but also to tailor the treatment.

Research objective

To evaluate the possible prognostic role of a staging system based on tumor penetration into the anal wall, in comparison with the traditional staging.

Research methods

This is a retrospective evaluation of 48 patients with squamocellular carcinoma of the anal canal, who underwent endoscopic US as part of a pre-treatment assessment including endoscopy with biopsy, pelvic magnetic resonance imaging, and total body computed tomography scan. All the tumors were staged with the traditional anal cancer staging system and with a novel US staging. All the patients were treated with definitive chemoradiation and subsequent follow-up. Overall and disease-free survival (DFS), as well as factors influencing survival were analyzed.

Research results

Median follow up was 108 mo. American Society of Anesthesiologists score, and US based staging system were related with DFS. By combining these two prognostic variables 4 groups with different prognoses were identified.

Research conclusions

A staging system based on tumor invasion is more similar to the staging of all other intestinal cancers and may better reflect a prognostic significance. By combining US staging with other prognostic variables, groups of patients with different prognoses can be determined. In the future the US staging could be introduced as one of the predictive clinical parameters in the setting of anal cancer, in order to improve the prognostic accuracy and possibly implement a tailored therapeutic approach.

Research perspectives

Anal cancer is a rare disease and prospective studies are difficult to conduct in a single center. The usefulness of the US staging system, in addition to traditional staging, as prognostic determinants, should be further validated in larger studies in order to plan treatment strategies based on risk categories.