Background: Anal cancer screening has allowed for the diagnosis of early-stage anal cancers; however, guidelines for the treatment of early anal cancers remain mixed given the scarcity of clinical trials and data. Management ranges from chemoradiation therapy to local surgical excision. Methods: This paper’s objective is to clarify the definition of early anal cancer and its management. Approval for this systematic review was obtained through PROSPERO [CRD42022304327]. Three independent reviewers screened the studies and performed data analysis, with conflicts resolved by a fourth reviewer. All information is presented according to the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA). The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria were used to assess the certainty of the evidence. Results: The MEDLINE, EMBASE and Cochrane databases were queried with 628 articles screened. A total of 15 articles were selected for inclusion. Early anal cancer was most often defined as T1-2N0M0 anal cancer but also included Superficially Invasive Squamous Cell Carcinoma (SISCCA). There were various treatments assessed for outcomes including local excision, chemoradiation, and radiation. The studies reported overall survival, cancer-specific survival, recurrence-free survival, and/or colostomy-free survival, leading to significant heterogeneity amongst the studies. No meta-analysis was possible. Conclusions: Poor-quality studies exist for the evaluation of the most effective treatment modality for early anal cancer. Surgical excision alone with adequate margins has equivocal results, but data is poor. Chemoradiation is successful but may be overtreatment. Randomized controlled studies are needed, as screening will result in earlier anal cancer diagnoses.
背景：肛门癌筛查使得早期肛门癌的诊断成为可能；然而，由于临床试验和数据的稀缺，早期肛门癌的治疗指南仍存在分歧。治疗方法从放化疗到局部手术切除不等。方法：本文旨在明确早期肛门癌的定义及其治疗管理。本系统综述已通过PROSPERO平台批准[CRD42022304327]。三位独立评审员筛选研究并进行数据分析，争议由第四位评审员解决。所有信息均按照系统综述和荟萃分析优先报告条目（PRISMA）呈现。采用推荐、评估、发展和评价分级（GRADE）标准评估证据的确定性。结果：检索MEDLINE、EMBASE和Cochrane数据库，共筛选628篇文章，最终纳入15篇。早期肛门癌最常定义为T1-2N0M0期肛门癌，也包括浅表浸润性鳞状细胞癌（SISCCA）。研究评估了多种治疗方法的结局，包括局部切除、放化疗和放疗。研究报告了总生存期、癌症特异性生存期、无复发生存期和/或无造口生存期，导致研究间存在显著异质性，无法进行荟萃分析。结论：现有关于早期肛门癌最有效治疗方式评估的研究质量较低。单纯手术切除（切缘充分）的效果尚无定论，且数据质量较差。放化疗虽有效，但可能存在过度治疗。随着筛查将导致更多早期肛门癌被诊断，有必要开展随机对照研究。
A Systematic Review Defining Early Anal Squamous Cell Carcinoma and Identifying Treatment
肿瘤(癌症)患者之家