The National Cancer Data Base report on carcinoma of the anus

BACKGROUND. The last 15 years have seen substantial advances in the management of anal carcinoma, primarily in the use of radiochemotherapy as definitive or adjuvant treatment. This study reviews the patterns of presentation, care, and outcome reflected in data from the National Cancer Data Base representing a broad range of medical centers. METHODS. Data on patients with anal carcinoma (on 1050 patients from 1988 and 1289 patients from 1993) were reviewed for patterns of care and presentation. The 1988 cases were also reviewed for outcome data. RESULTS. There was an increase in the use of chemotherapy between 1988 and 1993 (from 61.6% to 67.2%), and substantial differences were observed in the management of epidermoid carcinomas and adenocarcinomas. The majority of epidermoid carcinomas were managed nonsurgically, principally with combined chemotherapy and radiation, whereas three-fourths of patients with adenocarcinoma underwent surgery. The most important factors for favorable 5-year survival were early stage (ranging from 71.3% for Stage I to 23.1% for Stage IV), epidermoid carcinoma histology (57.6%, compared with 41.3% for adenocarcinoma), and female gender (56.2%, compared with 49.6% for males). For Stage I-II epidermoid carcinomas, the 5-year survival for patients who received nonsurgical treatment with radiochemotherapy was equivalent to that of patients who received surgical treatment (64.0% and 65.4%, respectively). CONCLUSIONS. This study confirms a trend in patterns of care favoring nonsurgical management with radiochemotherapy for epidermoid carcinomas of the anus. For adenocarcinomas, there has been a trend toward increasing use of multimodality therapy with surgery and adjuvant radiochemotherapy. Survival data from the 1988 cases confirmed the efficacy of conservative treatment with radiation plus chemotherapy for epidermoid carcinomas.