Prognostic Factors Derived from A Prospective Database Dictate Clinical Biology of Anal Cancer The Intergroup Trial (RTOG 98-11)

被引:120
作者
Ajani, Jaffer A. [1 ]
Winter, Kathryn A. [2 ]
Gunderson, Leonard L. [3 ]
Pedersen, John
Benson, Al B., III [4 ]
Thomas, Charles R., Jr. [5 ,6 ]
Mayer, Robert J. [7 ]
Haddock, Michael G. [8 ]
Rich, Tyvin A. [9 ]
Willett, Christopher G. [10 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Gastrointestinal Med Oncol, Houston, TX 77030 USA
[2] Radiat Therapy Oncol Grp, Philadelphia, PA USA
[3] Mayo Clin, Scottsdale, AZ USA
[4] Northwestern Univ, Chicago, IL USA
[5] Knight Canc Inst, Portland, OR USA
[6] Oregon Hlth & Sci Univ, Portland, OR USA
[7] Dana Farber Canc Inst, Boston, MA 02115 USA
[8] Mayo Clin, Rochester, MN USA
[9] Univ Virginia, Charlottesville, VA USA
[10] Duke Univ, Durham, NC USA
关键词
anal cancer; clinical biology; prognostic factors; prospective database; survival; SQUAMOUS-CELL CARCINOMA; EPIDERMOID CARCINOMA; RANDOMIZED-TRIAL; RADIOTHERAPY; CHEMOTHERAPY; MANAGEMENT; RADIATION; MITOMYCIN; THERAPY; CHEMORADIATION;
D O I
10.1002/cncr.25188
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND: Only 4 prospective randomized phase 3 trials have been reported for anal cancer. A prognostic factor analysis for anal cancer from a prospective database has been published from only 1 study (N = 110). To confirm and uncover new prognostic factors, we analyzed the prospective database of intergroup RTOG 98-11. METHODS: Univariate and multivariate analyses of the baseline characteristics for 5-year overall survival (OS) and disease-free survival (DFS) were carried out. Various combinations of tumor diameter and clinically positive nodes (N+) were analyzed to identify subgroups. RESULTS: A total of 644 were assessable and analyzed. Tumor diameter >5 cm was associated with poorer 5-year DFS (P = .0003) and poorer 5-year OS (P = .0031), and N+ was associated with poorer 5-year DFS (P <= .0001) and poorer 5-year OS (P = <= .0001) in the multivariate analysis. In stratified analyses, N+ had more adverse influence on DFS and OS than did tumor diameter. Patients with >5-cm tumor and N+ had the worst DFS (only 30% at 3 years compared with 74% for the best group; <5 cm primary and NO) and OS (only 48% at 4 years compared with 81% for the best group; <5 cm primary and NO). Men had worse DFS (P = .02) and OS (P = .016). These factors maintained their influence in each treatment arm. CONCLUSIONS: This prospective prognostic factor analysis establishes tumor diameter as an independent prognosticator of poorer 5-year DFS and OS and confirms N+ and male sex as poor prognostic factors. This analysis also uncovers novel subgroups (derived from combining prognostic factors) with incremental worsening of DFS and OS. Cancer 2010;116:4007-13. (C) 2010 American Cancer Society.
引用
收藏
页码:4007 / 4013
页数:7
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