Gastrointestinal Cancer

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SU_3_2030 - Patterns of Care and Outcomes for Early Stage (cT1-T2N0M0) Squamous Cell Carcinoma of the Anus

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Patterns of Care and Outcomes for Early Stage (cT1-T2N0M0) Squamous Cell Carcinoma of the Anus
I. Youssef1, V. W. Osborn1,2, E. Katsoulakis3, A. Kavi1,2, K. N. Choi1, J. Safdieh Jr1,4, and D. Schreiber5; 1SUNY Downstate Medical Center, Brooklyn, NY, 2Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 3US Department of Veterans Affairs, James A. Haley, Tampa, FL, 4Department of Radiation Oncology, Kings County Hospital Center, Brooklyn, NY, 5Summit Medical Group MD Anderson Cancer Center, Berkeley Heights, NJ

Purpose/Objective(s): Standard of care treatment for squamous cell carcinoma (SCC) of the anus is concurrent chemoradiation (CRT) however it is unclear whether CRT is necessary for very early stage, T1-2N0 anal cancer. We therefore sought to assess for predictors of use of CRT and its impact on overall survival (OS) in patients with early stage node negative SCC of the anus with favorable characteristics in a large hospital-based database.

Materials/Methods: The National Cancer Database (NCDB) was queried to identify patients who received CRT, defined as initiation of chemo and RT within 14 days of each other, or RT alone (without any chemo during initial treatment phase) for cT1-2N0M0 SCC of the anus. The cohort was limited to patients less than 70 years old with Charlson-Deyo Comorbidity Index of 0. Patients were stratified by age (<60, ≥60), gender (Male, Female), race (white, black, other),stage (cT1, cT2), facility type (academic, nonacademic), and insurance status (none, private, Medicaid, Medicare, other). Univariable and multivariable logistic regression were performed to assess for predictors of CRT usage. 5-year OS was analyzed using the Kaplan Meier method with the log rank test both for the full cohort and then on the subsets of T1 and T2 patients. Univariable and multivariable logistic regression were used to assess for covariables associated with survival differences.

Results: We identified 5,723 patients, of whom 5,425 (94.8%) received CRT and 298 (5.2%) received RT alone. Median follow up was 50.1 months. 68.7% were female and 89.8% were white. 33.7% and 66.3% of patients had cT1 and cT2 disease, respectively. Multivariable logistic regression showed patients were less likely to receive CRT if they were of black race (OR 0.448 (0.319-0.631), p<0.0001), and more likely to receive CRT if they had T2 disease (OR 2.199 (1.737-2.784), p<0.0001). Age, facility type and insurance status were not associated with use of CRT. 5-year OS was 85.3% overall, 86.0% for CRT and 72.8%% for RT (p<0.0001). For T1 patients, 5-yr OS was 88.4% overall, 89.0% with CRT and 81.5% with RT (p=0.008). For T2 patients, 5-year OS was 83.8% overall, 84.6% with CRT and 63.9% with RT (p<0.0001). Multivariable Cox regression analysis confirmed association between OS and CRT use, HR 0.508 (95% CI 0.402-0.641, p<0.0001).

Conclusion: The vast majority of patients under age 70 without significant comorbidities are treated with chemoradiation over radiation alone for early stage squamous cell carcinoma of the anus, with better survival associated with chemoradiation.

Author Disclosure: I. Youssef: None. V.W. Osborn: None. E. Katsoulakis: Stock; Novocure. A. Kavi: None. K.N. Choi: None. D. Schreiber: None.

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