The standard treatment for recurrent or persistent anal squamous cell carcinoma is surgical salvage, but disease control and survival are suboptimal. Patients treated for recurrent or persistent anal squamous cell carcinoma at our institution from 2002 to 2022 were included. Patients were classified by type of salvage treatment received: surgery alone vs. reirradiation followed by surgery and by whether they received intraoperative radiation at the time of surgery. Clinical and pathologic variables were collected and assessed for association with risk of second local recurrence and death from any cause. Sixty four patients were included; 55(85.9%) were treated with surgery alone and 9 (14.1%) were treated with reirradiation followed by surgery. Median (IQR) follow up from the time of salvage treatment was 40.0 (20.3-68.0) months. The 3-year cumulative incidence of second local recurrence (95% CI) after salvage surgery was 36% (24%-48%); 39% (26%-52%) for patients treated with surgery alone and 15% (0.46%-51%) for patients treated with reirradiation followed by surgery. Factors associated with increased second local recurrence after salvage surgery included a locoregional recurrence, lymphovascular space invasion and positive surgical margins. The 3-year overall survival (95% CI) after salvage surgery was 70% (59%-83%); 68% (7%-56%) after surgery alone and 89% (10.5%-70.6%) after reirradiation followed by surgery. Factors associated with worse overall survival included male sex, a larger recurrent tumor and positive surgical margins. Approximately 60% of patients achieved pelvic control after salvage therapy for recurrent or persistent anal squamous cell carcinoma. Although receipt of reirradiation and intraoperative radiation were not associated with improved second local recurrence or overall survival in our cohort, patients with positive surgical margins and lymphovascular space invasion on surgical pathology had higher rates of pelvic recurrence after salvage surgery and may benefit from escalated salvage therapy.

中文翻译：

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复发性或持续性肛门鳞状细胞癌的挽救治疗：多模式治疗的作用

复发性或持续性肛门鳞状细胞癌的标准治疗是手术抢救，但疾病控制和生存率并不理想。2002 年至 2022 年在我们机构接受复发性或持续性肛门鳞状细胞癌治疗的患者也被纳入其中。根据所接受的挽救治疗类型对患者进行分类：单独手术与手术后再放疗以及手术时是否接受术中放疗。收集并评估临床和病理变量与第二次局部复发和任何原因死亡的风险的关联。包括 64 名患者；55 例（85.9%）仅接受手术治疗，9 例（14.1%）接受再放疗后再手术治疗。自挽救治疗起的中位随访时间 (IQR) 为 40.0 (20.3-68.0) 个月。挽救性手术后3年累积第二次局部复发发生率（95% CI）为36%（24%-48%）；仅接受手术治疗的患者为 39% (26%-52%)，接受再放疗后再进行手术治疗的患者为 15% (0.46%-51%)。与挽救手术后第二次局部复发增加相关的因素包括局部区域复发、淋巴管间隙侵犯和手术切缘阳性。挽救手术后3年总生存率（95% CI）为70%（59%-83%）；单独手术后为 68% (7%-56%)，再放疗后再手术后为 89% (10.5%-70.6%)。与较差的总体生存率相关的因素包括男性、较大的复发肿瘤和阳性手术切缘。约 60% 的复发性或持续性肛门鳞状细胞癌患者在抢救治疗后实现了骨盆控制。尽管在我们的队列中接受再放疗和术中放疗与改善第二次局部复发或总生存率无关，但手术切缘阳性和手术病理学上淋巴血管间隙侵犯的患者在挽救性手术后盆腔复发率较高，可能会受益于升级的挽救性治疗。