Prognosis

Tumour diameter >5 cm, male sex, and lymph node involvement are associated with worse overall survival and worse disease-free survival.[60][61]

Stage 2B (>5 cm) anal squamous cell cancer was significantly associated with worse survival compared with stage 2A (2-5 cm) cancer in two cohorts (National Cancer Database [NCDB] 2004-2014 and the Surveillance, Epidemiology, and End Results [SEER] database [1988-2013]).[62] Five-year overall survival was 72% and 69% for stage 2A versus 57% and 50% for stage 2B in the NCDB and SEER databases, respectively (P <0.001).

Overall results

The 5-year survival rates for people diagnosed with anal cancer between 2010 and 2016 were:[63]

  • 82% for people with localised disease

  • 66% for people with regional disease

  • 34% for people with distant metastatic disease.

Outcome by T stage

Treatment failure increases with increasing T stage. Based on people diagnosed with anal cancer between 2008 and 2014, one study reported that, among patients with T1 anal cancer, 11% had local failure compared with 24% for those with T2, 45% for those with T3, and 43% for those with T4. There was a corresponding decrease in 5-year survival (95% for those with T1, 79% for T2, 53% for T3, and 19% for T4).[64] Five-year colostomy-free survival also decreases with stage.[60][65]

Outcome by N stage

In contrast to T stage, the impact of positive lymph nodes is less clear.

Unlike rectal cancer, inguinal lymph nodes in anal cancer are considered nodal metastasis (N+) rather than distant metastasis (M1), and patients should be treated in a curative fashion.

Node positive status has been associated with locoregional treatment failure and worse overall survival in some studies.[66][67][68]

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