Rare study highlights anal cancer prognosis risks

The presence of palpable, clinically involved inguinal lymph nodes (PCIINs) and male gender are both independent risk factors for poor prognosis in anal cancer, confirm the results of a UK analysis.

The researchers analyzed data from 292 patients in the Anal Cancer Trial (ACT) I trial who received chemoradiation between 1987 and 1994. From this, they generated prognostic scores for locoregional failure at 2 years, anal cancer death at 5 years, and overall survival at 5 years.

Regression analysis showed that male gender and PCIINs were independent risk factors for all three endpoints.

In comparison with women, the risk for locoregional failure was 60% greater (36 vs 26%), for anal cancer death was 80% greater (39 vs 25%), and for any death was 56% greater for men (82 vs 57%). Meanwhile, the presence of PCIINs increased the risk for locoregional failure by 87% (40 vs 28%), and for anal cancer death by 83% (45 vs 27%), and led to significantly worse overall survival compared with patients with inpalpable nodes.

After adjusting for gender and lymph node status, the authors also found that lower hemoglobin level increased the risk for anal cancer death, while increased baseline white blood cell count reduced overall survival.

"The use of hemoglobin as a risk-stratification factor may be useful in future trials and may provide a method with which to identify patients who might benefit from future methods of hypoxic modification of radiotherapy," Robert Glynne-Jones (Mount Vernon Center for Cancer Treatment, Northwood, UK) and colleagues write in Cancer.

They add that pretreatment white blood cell count may be prognostic due to the role of inflammation in cancer progression.

The authors say that their findings concur with those from the only two other randomized trials to report prognostic analyses, and could help to improve treatment.

"In the future, clinical, epigenetic, genetic, and germ-line variables could be used to develop a model that predicts response to therapy and prognosticates outcome. The first step in developing such models may be the establishment of reliable prognostic factors and their interaction."

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