title: Salvage abdominoperineal resection for anal cancer following chemoradiation: a proposed scoring system for predicting postoperative survival.
abstract: OBJECTIVE
  Anal carcinoma is treated primarily by chemoradiation. Failure of this treatment requires salvage surgery. The aims of this retrospective study were to assess the survival probability after rescue surgery and design a pathological risk score (PRS) to predict postoperative outcome.
  
  
  METHODS
  From 1982 to 2011, the clinical and pathological data of 111 patients treated with chemoradiation or radiation alone and abdominoperineal resection were reviewed. The Kaplan-Meier method was used to assess overall survival and parametric modeling was applied to determine prognostic factors and design a PRS.
  
  
  RESULTS
  The 2- and 5-year overall survival rates were 60% and 24.5%, respectively. The multivariate analysis showed that nodal disease (P < 0.03), resection margin (P < 0.001), and perineural and/or lymphovascular invasion (P < 0.0001) were significantly associated with survival. Patients who presented negative values for these three variables were estimated to show a 5-year survival rate of 55% compared with 0.03% for patients who presented positive values.
  
  
  CONCLUSIONS
  Positive surgical margin, the presence of perineural and/or lymphovascular invasion and positive nodal involvement were identified as significant independent predictors of mortality. The PRS was shown to be highly predictive of postoperative outcome.
authors.affiliation: Department of Abdomino-Pelvic Surgery, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil. sicorrea@uol.com.br
authors.forename: Jose Humberto S
authors.initials: JH
authors.lastname: Correa
authors.forename: Leonaldson S
authors.initials: LS
authors.lastname: Castro
authors.forename: Rubens
authors.initials: R
authors.lastname: Kesley
authors.forename: Jurandir A
authors.initials: JA
authors.lastname: Dias
authors.forename: Jose Paulo
authors.initials: JP
authors.lastname: Jesus
authors.forename: Luiz O
authors.initials: LO
authors.lastname: Olivatto
authors.forename: Ivanir O
authors.initials: IO
authors.lastname: Martins
authors.forename: Fabio P
authors.initials: FP
authors.lastname: Lopasso
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D001005:Anus Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010502:Perineum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy