Prognostic Factors of Long-Term Outcomes after Primary Chemo-Radiotherapy in Non-Metastatic Anal Squamous Cell Carcinoma: An International Bicentric Cohort

Radiomics to predict tumor response to combination chemoradiotherapy in squamous cell carcinoma of the anal canal: a preliminary investigation

BACKGROUND

Upfront combination chemoradiotherapy (CRT) represents the standard of care for patients affected by stage III squamous cell carcinoma (SCC) of the anal canal, achieving satisfactory results both in terms of overall survival and local disease control. However, a non-negligible fraction of patients obtain incomplete responses, highlighting the need for innovative prognostic tools. We report the preliminary results of a customized radiomic algorithm designed to predict tumor response to CRT in patients affected by SCC of the anal canal.

METHODS

We manually annotated pretreatment T2-weighted turbo spin-echo images of 26 consecutive patients with stage III SCC of the anal canal treated with CRT at our institution from 2012 to 2022. Each patient was classified as complete response (CR, 17 patients), or non-complete response (non-CR, 9 patients) based on the absence or presence of residual disease at imaging and endoscopy after treatment. A total of 132 three-dimensional radiomic features were extracted for each patient and fed to a dedicated machine-learning classifier.

RESULTS

Models trained with gray-level co-occurrence matrix features achieved the best performances (accuracy 0.846 ± 0.064, sensitivity 0.900 ± 0.122, specificity 0.833 ± 0.175, area under receiver operating characteristics curve 0.867 ± 0.055), highlighting a more homogeneous distribution of voxel intensities and lower spatial complexity in non-CR patients.

CONCLUSION

Our radiomic tool accurately predicted tumor response to CRT in patients with stage III SCC of the anal canal, highlighting a more homogeneous tissue composition in poor responders.

RELEVANCE STATEMENT

The more homogeneous radiomic texture observed in non-CR patients may be imputable to a dominant neoplastic clone with a relatively low mitotic index (therefore, limited tissue necrosis), intrinsically more resistant to CRT than faster-proliferating tumors.

KEY POINT

A non-negligible fraction of patients with anal SCC respond unsatisfactorily to CRT. Our radiomic model predicted response to CRT based on pretreatment MRI. We observed a more homogeneous tissue composition in poor responders. The slow proliferation of a dominant clone may explain non-CR to CRT.

Factors Influencing Outcomes and Survival in Anal Cancer

BACKGROUND

We aim to ascertain prognostic factors in the current management of anal cancer within this study.

METHODS

We reviewed the management and outcomes of anal cancer cases over a seven-year period, inclusive (2016-2023). The primary objectives were to assess the demographic characteristics, clinical presentation, and outcomes of all anal cancer patients within our institution. Kaplan-Meier survival analysis was used to estimate survival differences between cohorts, with statistical significance determined using log-rank testing. Cox proportional hazards regression was utilised to identify prognostic factors. Cox regression hazard ratios were reported along with confidence intervals and p-values.

RESULTS

The median follow-up time for the study was 29.8 months. Seventy-five patients with anal cancer were included in this study, with 88% (66/75) being squamous cell carcinoma (SCC) and the majority having regional disease (82.7% (62/75)). The median age at diagnosis was 63.4 years (36-94). There was a female preponderance (57.3% (43/75)). In total, 84% (63/75) underwent definitive chemoradiation (dCRT), with 7/63 (11.1%) requiring a salvage abdomino-perineal resection (APR) for residual or recurrent disease. Adverse prognostic indicators include those with T4 disease hazard ratio = 3.81, (95% CI 1.13-12.83, * p = 0.04), poorly differentiated tumour disease HR = 3.37, (95% CI 1.13-10.02, * p = 0.04), having N2 nodal status HR = 5.03, (95% CI 1.11-22.8, * p = 0.04), and having metastatic disease at diagnosis HR = 5.8, (95% CI 1.28-26.42, * p = 0.02).

CONCLUSION

Presenting characteristics including stage, nodal, and differentiation status remain key prognostic indicators in those diagnosed with anal malignancy.

Unraveling Emerging Anal Cancer Clinical Biomarkers from Current Immuno-Oncogenomics Advances

Anal squamous cell carcinoma (ASCC) is a rare gastrointestinal malignancy associated with high-risk human papillomavirus (HPV) and is currently one of the fastest-growing causes of cancer incidence and mortality in developed countries. Although next-generation sequencing technologies (NGS) have revolutionized cancer and immuno-genomic research in various tumor types, a limited amount of clinical research has been developed to investigate the expression and the functional characterization of genomic data in ASCC. Herein, we comprehensively assess recent advancements in "omics" research, including a systematic analysis of genome-based studies, aiming to identify the most relevant ASCC cancer driver gene expressions and their associated signaling pathways. We also highlight the most significant biomarkers associated with anal cancer progression, gene expression of potential diagnostic biomarkers, expression of therapeutic drug targets, and emerging treatment opportunities. This review stresses the urgent need for developing target-specific therapies in ASCC. By illuminating the molecular characteristics and drug-target expression in ASCC, this study aims to provide insights for the development of precision medicine in anal cancer.