Abstract：
OBJECTIVE: Anal cancer is primarily treated using concurrent chemoradiotherapy (CRT), with conformal techniques such as intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) now being the standard techniques utilised across the world. Despite this, there is still very limited consensus on prognostic factors for outcome following conformal CRT. This systematic review aims to evaluate the existing literature to identify prognostic factors for a variety of oncological outcomes in anal cancer, focusing on patients treated with curative intent using contemporary conformal radiotherapy techniques.
METHODS: A literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results.
RESULTS: The results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study - pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors.
CONCLUSIONS: Establishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.
METHODS: A literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results.
RESULTS: The results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study - pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors.
CONCLUSIONS: Establishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.
摘要：
目的：肛门癌主要使用同步放化疗（CRT）治疗，适形技术，如强度调制放射治疗（IMRT）和体积电弧治疗（VMAT），现在是世界各地使用的标准技术。尽管如此,关于适形CRT后预后因素的共识仍然非常有限.本系统综述旨在评估现有文献，以确定肛门癌各种肿瘤预后的预后因素。专注于使用当代适形放射治疗技术治疗的患者。
方法：使用Medline和Embase进行文献检索，以确定报告保形CRT治疗肛门癌后生存预后因素和癌症相关结局的研究。在单变量和多变量分析中被确定为显著的预后因素，以及它们各自的因素效应(如果有的话)被提取出来。最终结果中仅包括一项以上研究中报道的预后因素。
结果：分析了19项研究的结果。在单变量和多变量分析中，N级,T级,在所探讨的大多数结局中,性别是最普遍和最可靠的临床预后因素.通过一项以上的研究，只有少数生物标志物被确定为预后-治疗前活检HPV载量，以及白细胞增多的存在，基线测量时中性粒细胞增多和贫血。结果还强调了缺乏大型队列研究来探索影像学因素的预后意义。
结论：建立一组肛门癌预后和潜在预测因素可以指导患者的风险分层，帮助设计未来的临床试验。这样的试验将为我们提供更深入的见解，以了解如何使用更个性化的方法有效地治疗这种疾病。
方法：使用Medline和Embase进行文献检索，以确定报告保形CRT治疗肛门癌后生存预后因素和癌症相关结局的研究。在单变量和多变量分析中被确定为显著的预后因素，以及它们各自的因素效应(如果有的话)被提取出来。最终结果中仅包括一项以上研究中报道的预后因素。
结果：分析了19项研究的结果。在单变量和多变量分析中，N级,T级,在所探讨的大多数结局中,性别是最普遍和最可靠的临床预后因素.通过一项以上的研究，只有少数生物标志物被确定为预后-治疗前活检HPV载量，以及白细胞增多的存在，基线测量时中性粒细胞增多和贫血。结果还强调了缺乏大型队列研究来探索影像学因素的预后意义。
结论：建立一组肛门癌预后和潜在预测因素可以指导患者的风险分层，帮助设计未来的临床试验。这样的试验将为我们提供更深入的见解，以了解如何使用更个性化的方法有效地治疗这种疾病。
