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中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 433 -439. doi: 10.3877/cma.j.issn.2095-3224.2020.05.001

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肛管鳞癌诊治研究进展
林曜1, 张鹏1, 陶凯雄1,()   
  1. 1. 430022 武汉,华中科技大学同济医学院附属协和医院胃肠外科
  • 收稿日期:2019-09-28 出版日期:2020-10-25
  • 通信作者: 陶凯雄
  • 基金资助:
    国家自然科学基金(No. 81702386,No. 81874184); 希思科-豪森肿瘤研究基金(No.Y-HS2019-38)

Progress in diagnosis and treatment of squamous cell anal carcinoma

Yao Lin1, Peng Zhang1, Kaixiong Tao1,()   

  1. 1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2019-09-28 Published:2020-10-25
  • Corresponding author: Kaixiong Tao
引用本文:

林曜, 张鹏, 陶凯雄. 肛管鳞癌诊治研究进展[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(05): 433-439.

Yao Lin, Peng Zhang, Kaixiong Tao. Progress in diagnosis and treatment of squamous cell anal carcinoma[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(05): 433-439.

肛管鳞癌(SCAC)是一种少见的恶性肿瘤,但近年来发病率持续增高。SCAC是HPV相关鳞癌,其危险因素包括HPV、HIV感染、高风险性生活等。SCAC症状与直肠腺癌相似,诊断以病理活检为金标准,另可行18F-FDG PET/CT扫描检测淋巴结转移水平。此外各指南更新了SCAC的最新TNM分期和临床分期。SCAC治疗手段以放化疗为主,手术切除为辅。近年来放化疗方案已不仅是传统的5-氟尿嘧啶+丝裂霉素/铂类+放疗方案,卡培他滨及紫杉醇等药物以及调强适形放射治疗(IMRT)等先进放疗技术相继应用到治疗中。同时靶向及免疫治疗运用于SCAC治疗的相关研究也在积极开展中。

Squamous cell anal carcinoma (SCAC) is a cancer with a low incidence, but the incidence has continued to increase in recent years. SCAC is a HPV-associated squamous cell carcinoma with risk factors including HPV, HIV infection, and high-risk life. The symptoms of SCAC are similar to those of rectal adenocarcinoma. The diagnosis is based on pathological biopsy, and 18F-FDG PET / CT scan is feasible to detect lymph node metastasis levels. In addition, the guidelines update the latest TNM staging and clinical staging of SCAC. The treatment of SCAC is mainly chemoradiotherapy, supplemented by surgical resection. In recent years, the chemoradiotherapy scheme has not only been the traditional 5-fluorouracil + mitomycin/platinum + RT scheme, drugs such as capecitabine, paclitaxel and other advanced radiotherapy technologies such as IMRT have been added to the therapeutic schedule. At the same time, related research on targeting and immunotherapy for SCAC treatment is also actively underway.

表1 AJCC第八版与第七版TNM分期比较[25,26]
[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019 [J]. CA Cancer J Clin, 2019, 69(1): 7-34.
[2]
Shiels MS, Kreimer AR, Coghill AE, et al. Anal cancer incidence in the United States, 1977-2011: distinct patterns by histology and behavior [J]. Cancer Epidemiol Biomarkers Prev, 2015, 24(10): 1548-1556.
[3]
张荣欣,陈功,肖植涛. 手术不再是肛管鳞癌的首选标准治疗模式: ESMO肛管癌临床实践指南解读[J/CD]. 中华结直肠疾病电子杂志, 2016, 5(3): 214-217.
[4]
Valvo F, Ciurlia E, Avuzzi B, et al. Cancer of the anal region [J]. Crit Rev Oncol Hematol, 2019, 135(1): 15-27.
[5]
Davis KG, Orangio GR. Basic science, epidemiology, and screening for anal intraepithelial neoplasia and its relationship to anal squamous cell cancer [J]. Clin Colon Rectal Surg, 2018, 31(6): 368-378.
[6]
Fazendin EA, Crean AJ, Fazendin JM, et al. Coondyloma acuminatum, anal intraepithelial neoplasia, and anal cancer in the setting of hiv: do we really understand the risk? [J]. Dis Colon Rectum, 2017, 60(10): 1078-1082.
[7]
Islami F, Ferlay J, Lortet-tieulent J, et al. International trends in anal cancer incidence rates [J]. Int J Epidemiol, 2017, 46(3): 924-938.
[8]
Nelson RA, Levine AM, Bernstein L, et al. Changing patterns of anal canal carcinoma in the United States [J]. J Clin Oncol, 2013, 31(12): 1569-1575.
[9]
Serrano B, De Sanjosé S, Tous S, et al. Human papillomavirus genotype attribution for HPVs 6, 11, 16, 18, 31, 33, 45, 52 and 58 in female anogenital lesions [J]. Eur J Cancer, 2015, 51(13): 1732-1741.
[10]
Poon MKL, Wong JPH, Li ATW, et al. HIV-positive MSM′s knowledge of HPV and anal cancer self-sampling: A scoping review [J]. Curr Oncol, 2018, 25(1): e83-e89.
[11]
Grew D, Bitterman D, Leichman CG, et al. HIV infection is associated with poor outcomes for patients with anal cancer in the highly active antiretroviral therapy era [J]. Dis Colon Rectum, 2015, 58(12): 1130-1136.
[12]
Conley LJ, Bush TJ, Darragh TM, et al. Incidence and predictors of abnormal anal cytology findings among hiv-infected adults receiving contemporary antiretroviral therapy [J]. J Infect Dis, 2016, 213(3): 351-360.
[13]
Coffey K, Beral V, Green J, et al. Lifestyle and reproductive risk factors associated with anal cancer in women aged over 50 years [J]. Br J Cancer, 2015, 112(9): 1568-1574.
[14]
Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review [J]. World J Gastrointest Surg, 2016, 8(1): 41-51.
[15]
Gonçalves JCN, Macedo ACL, Madeira K, et al. Accuracy of anal cytology for diagnostic of precursor lesions of anal cancer: systematic review and meta-analysis [J]. Dis Colon Rectum, 2019, 62(1): 112-120.
[16]
Crawshaw BP, Russ AJ, Stein SL, et al. High-resolution anoscopy or expectant management for anal intraepithelial neoplasia for the prevention of anal cancer: is there really a difference? [J]. Dis Colon Rectum, 2015, 58(1): 53-59.
[17]
Dempsey AF, Pyrznawoski J, Lockhart S, et al. Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial [J]. JAMA Pediatr, 2018, 172(5): e180016.
[18]
Gray P, Luostarinen T, Vänskä S, et al. Occurrence of human papillomavirus (HPV) type replacement by sexual risk-taking behaviour group: Post-hoc analysis of a community randomized clinical trial up to 9 years after vaccination (IV) [J]. Int J Cancer, 2019, 145(3): 785-796.
[19]
李昂,魏芳. 宫颈癌预防性HPV疫苗应用现状及面临的挑战 [J]. 国际肿瘤学杂志, 2019, 46(5): 307-310.
[20]
Shridhar R, Shibata D, Chan E, et al. Anal cancer: current standards in care and recent changes in practice [J]. CA Cancer J Clin, 2015, 65(2): 139-162.
[21]
Albertsson P, Alverbratt C, Liljegren A, et al. Positron emission tomography and computed tomographic (PET/CT) imaging for radiation therapy planning in anal cancer: A systematic review and meta-analysis [J]. Crit Rev Oncol Hematol, 2018, 126: 6-12.
[22]
Jones M, Hruby G, Solomon M, et al. The role of FDG-PET in the initial staging and response assessment of anal cancer: a systematic review and meta-analysis [J]. Ann Surg Oncol, 2015, 22(11): 3574-3581.
[23]
Glynne-jones R, Nilsson PJ, Aschele C, et al. Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J]. Ann Surg Oncol, 2014, 25(Suppl 3): iii10-20.
[24]
Sekhar H, Zwahlen M, Trelle S, et al. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study [J]. Lancet Oncol, 2017, 18(10): 1348-1359.
[25]
National Comprehensive Cancer Network. Anal Carcinoma (Version2. 2019)[EB/OL]. (2019-08-28) [2019-09-25]

URL    
[26]
National Comprehensive Cancer Network. Anal Carcinoma(Version1. 2016)[EB/OL]. (2016-03-15) [2019-09-25]

URL    
[27]
Chai CY, Tran Cao HS, Awad S, et al. Management of stage I squamous cell carcinoma of the anal canal [J]. JAMA Surg, 2018, 153(3): 209-215.
[28]
Ko G, Sarkaria A, Merchant SJ, et al. A systematic review of outcomes after salvage abdominoperineal resection for persistent or recurrent anal squamous cell cancer [J]. Colorectal Dis, 2019, 21(6): 632-650.
[29]
Nigro ND, Vaitkevicius VK, Considine B. Combined therapy for cancer of the anal canal: a preliminary report [J]. Dis Colon Rectum, 17(3): 354-356.
[30]
Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research [J]. Lancet, 1996, 348(9034): 1049-1054.
[31]
Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups [J]. J Clin Oncol, 1997, 15(5): 2040-2049.
[32]
Hatfield P, Cooper R, Sebag-montefiore D. Involved-field, low-dose chemoradiotherapy for early-stage anal carcinoma [J]. Int J Radiat Oncol Biol Phys, 2008, 70(2): 419-424.
[33]
Hu K, Minsky BD, Cohen AM, et al. 30 Gy may be an adequate dose in patients with anal cancer treated with excisional biopsy followed by combined-modality therapy [J]. J Surg Oncol, 1999, 70(2): 71-77.
[34]
Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study [J]. J Clin Oncol, 1996, 14(9): 2527-2539.
[35]
Hung A, Crane C, Delclos M, et al. Cisplatin-based combined modality therapy for anal carcinoma: a wider therapeutic index [J]. Cancer, 2003, 97(5): 1195-1202.
[36]
Gunderson LL, Winter KA, Ajani JA, et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin [J]. J Clin Oncol, 2012, 30(35): 4344-4351.
[37]
James RD, Glynne-jones R, Meadows HM, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2×2 factorial trial [J]. Lancet Oncol, 2013, 14(6): 516-524.
[38]
Meulendijks D, Dewit L, Tomasoa NB, et al. Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option [J]. Br J Cancer, 2014, 111(9): 1726-1733.
[39]
Goodman KA, Julie D, Cercek A, et al. Capecitabine with mitomycin reduces acute hematologic toxicity and treatment delays in patients undergoing definitive chemoradiation using intensity modulated radiation therapy for anal cancer [J]. Int J Radiat Oncol Biol Phys, 2017, 98(5): 1087-1095.
[40]
Sclafani F, Morano F, Cunningham D, et al. Platinum-fluoropyrimidine and paclitaxel-based chemotherapy in the treatment of advanced anal cancer patients [J]. Oncologist, 2017, 22(4): 402-408.
[41]
de Bari B, Lestrade L, Franzetti-pellanda A, et al. Modern intensity-modulated radiotherapy with image guidance allows low toxicity rates and good local control in chemoradiotherapy for anal cancer patients [J]. J Cancer Res Clin Oncol, 2018, 144(4): 781-789.
[42]
Paliga A, Onerheim R, Gologan A, et al. EGFR and K-ras gene mutation status in squamous cell anal carcinoma: a role for concurrent radiation and EGFR inhibitors? [J]. Br J Cancer, 2012, 107(11): 1864-1868.
[43]
Sparano JA, Lee JY, Palefsky J, et al. Cetuximab plus chemoradiotherapy for HIV-associated anal carcinoma: a phase II aids malignancy consortium trial [J]. J Clin Oncol, 2017, 35(7): 727-733.
[44]
Ott PA, Piha-paul SA, Munster P, et al. Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal [J]. Ann Oncol, 2017, 28(5): 1036-1041.
[45]
Morris VK, Salem ME, Nimeiri H, et al. Nivolumab for previously treated unresectable metastatic anal cancer (NCI9673): a multicentre, single-arm, phase 2 study [J]. Lancet Oncol, 2017, 18(4): 446-453.
[46]
Boman BM, Moertel CG, O′connell MJ, et al. Carcinoma of the anal canal. A clinical and pathologic study of 188 cases [J]. Cancer, 1984, 54(1): 114-125.
[47]
Gunderson LL, Moughan J, Ajani JA, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial [J]. Int J Radiat Oncol Biol Phys, 2013, 87(4): 638-645.
[48]
Leon O, Guren M, Hagberg O, et al. Anal carcinoma - Survival and recurrence in a large cohort of patients treated according to Nordic guidelines [J]. Radiother Oncol, 2014, 113(3): 352-358.
[49]
Schernberg A, Escande A, Rivin Del Campo E, et al. Leukocytosis and neutrophilia predicts outcome in anal cancer [J]. Radiother Oncol, 2017, 122(1): 137-145.
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