A National-Level Validation of the New American Joint Committee on Cancer 8th Edition Subclassification of Stage IIA and B Anal Squamous Cell Cancer

Paolo Goffredo; Mattia Garancini; Timothy J Robinson; Jessica Frakes; Hisakazu Hoshi; Imran Hassan

doi:10.1245/s10434-018-6449-y

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A National-Level Validation of the New American Joint Committee on Cancer 8th Edition Subclassification of Stage IIA and B Anal Squamous Cell Cancer

Journal article

Peer reviewed

A National-Level Validation of the New American Joint Committee on Cancer 8th Edition Subclassification of Stage IIA and B Anal Squamous Cell Cancer

Paolo Goffredo, Mattia Garancini, Timothy J Robinson, Jessica Frakes, Hisakazu Hoshi and Imran Hassan

Annals of surgical oncology, Vol.25(6), pp.1654-1660

06/2018

DOI: 10.1245/s10434-018-6449-y

PMID: 29572706

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Abstract

The 8th edition of the American Joint Committee on Cancer (AJCC) updated the staging system of anal squamous cell cancer (ASCC) by subdividing stage II into A (T2N0M0) and B (T3N0M0) based on a secondary analysis of the RTOG 98-11 trial. We aimed to validate this new subclassification utilizing two nationally representative databases. The National Cancer Database (NCDB) [2004-2014] and the Surveillance, Epidemiology, and End Results (SEER) database [1988-2013] were queried to identify patients with stage II ASCC. A total of 6651 and 2579 stage IIA (2-5 cm) and 1777 and 641 stage IIB (> 5 cm) patients were identified in the NCDB and SEER databases, respectively. Compared with stage IIB patients, stage IIA patients within the NCDB were more often females with fewer comorbidities. No significant differences were observed between age, race, receipt of chemotherapy and radiation, and mean radiation dose. Demographic, clinical, and pathologic characteristics were comparable between patients in both datasets. The 5-year OS was 72% and 69% for stage IIA versus 57% and 50% for stage IIB in the NCDB and SEER databases, respectively (p < 0.001). After adjustment for available demographic and clinical confounders, stage IIB was significantly associated with worse survival in both cohorts (hazard ratio 1.58 and 2.01, both p < 0.001). This study validates the new AJCC subclassification of stage II anal cancer into A and B based on size (2-5 cm vs. > 5 cm) in the general ASCC population. AJCC stage IIB patients represent a higher risk category that should be targeted with more aggressive/novel therapies.

SEER Program

Age Factors

Carcinoma, Squamous Cell - pathology

Humans

Carcinoma, Squamous Cell - therapy

Male

Survival Rate

Anus Neoplasms - pathology

Tumor Burden

Radiotherapy

Neoplasm Staging - methods

Sex Factors

Anus Neoplasms - therapy

Female

Details

Title: Subtitle: A National-Level Validation of the New American Joint Committee on Cancer 8th Edition Subclassification of Stage IIA and B Anal Squamous Cell Cancer
Creators: Paolo Goffredo - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Mattia Garancini - Department of Surgery, University of Milano-Bicocca, Monza, Italy
Timothy J Robinson - Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
Jessica Frakes - Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
Hisakazu Hoshi - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Imran Hassan - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. ihassan@mercycare.org
Resource Type: Journal article
Publication Details: Annals of surgical oncology, Vol.25(6), pp.1654-1660
Publisher: United States
DOI: 10.1245/s10434-018-6449-y
PMID: 29572706
ISSN: 1068-9265
eISSN: 1534-4681
Language: English
Date published: 06/2018
Academic Unit: Surgery
Record Identifier: 9984051588702771

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