Trends in primary surgery and overall survival in non-metastatic anal cancer - a population-based analysis

Q: What treatment is considered standard for non-metastatic anal cancer, and when is surgery usually used?

Chemoradiation is the standard curative-intent treatment. Surgery is generally reserved for patients who do not respond or who have persistent or progressive disease after initial therapy.

Q: How did the use of upfront primary surgery change from 2004 to 2020?

Primary surgery decreased from 46.0% in 2004 to 28.7% in 2020, reflecting a shift toward chemoradiation-first management.

Q: Which patient factors were associated with higher odds of receiving primary surgery?

Adjusted analyses showed higher odds among younger patients (<50 vs 60–69), males, and Non-Hispanic Black patients compared with Non-Hispanic White patients.

Sep 22, 2026

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Anal cancer incidence continues to rise in the United States, and standard curative-intent management for non-metastatic squamous cell carcinoma is chemoradiation, with surgery typically reserved for non-responders. This population-based analysis using SEER (2004–2020) evaluates how frequently upfront primary surgery is used and how overall survival changes over time. Among 16,718 patients, primary surgery declined while survival improved, with younger age, male sex, and specific tumor staging linked to higher surgical use.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Implications for Practice

Trends in primary surgery and overall survival in non-metastatic anal cancer: a population-based analysis Chan Shen1,*, , Madison Conces2, Kristen Ciombor3, Jennifer Dorth4, Joshua E. Meyer5, Timothy M. Geiger6, Aimal Khan6, Jeneth Aquino7, Natalie A. Lockney8, A. Bapsi Chakravarthy8, Jennifer Whisenant8, , Al B. Benson9, Cathy Eng3, 1College of Medicine, Departments of Surgery and Public Health Sciences, Pennsylvania State University, Hershey, PA 17033, United States 2 University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, United States 3 Division Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, United States 4 Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States 5 Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States 6Section of Colon and Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States 7Vanderbilt University School of Medicine, Nashville, TN 37232, United States 8 Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, United States 9 Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, United States *Corresponding author: Chan Shen, PhD, College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey, PA 17033-0850, USA ([cshen@pennstatehealth.psu.edu](cshen@pennstatehealth.psu.edu)) . Abstract Background: Anal cancer incidence is rising in the United States, now exceeding 10 000 cases annually. Chemoradiation (CRT) is the standard curative-intent treatment for non-metastatic squamous cell carcinoma of the anus (SCCA), with surgery generally reserved for non-responders with persistent or progressive disease. Recent trials have refined management, supporting the assessment of response at 26 weeks before considering surgery. However, contemporary population-level patterns of upfront primary surgery and associated survival trends remain incompletely described. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) registry (2004-2020), we identified adults with newly diagnosed non-metastatic anal squamous cell neoplasms (ICD-O-3 8050-8089). Outcomes were receipt of primary surgery as initial treatment and overall survival. We evaluated temporal trends (Cochran–Armitage), factors associated with primary surgery (multivariable logistic regression), and survival over time (Kaplan–Meier; multivariable Cox proportional hazards modeling). Results: Among 16 718 patients with non-metastatic anal cancer, 33.1%(n = 5529) underwent primary surgery and 83.7%(n = 13 997) received radiation as part of initial management. Primary surgery declined from 46.0% in 2004 to 28.7% in 2020 (trend P < 0.001), while radiation utilization was relatively stable over time (trend P = 0.106). In adjusted analyses, younger age (<50 vs 60-69 years; OR 1.614), male sex (OR 1.508), and Non-Hispanic Black race (vs Non-Hispanic White; OR 1.178) were associated with higher odds of primary surgery. Tumor factors were strongly associated with surgical use (eg, T1 vs T2: OR 3.072; higher N stage associated with lower odds). Overall survival improved across diagnosis periods (logrank P = 0.0002); in adjusted Cox models, diagnosis in 2016-2020 (vs 2004-2007) was associated with lower mortality risk (HR 0.77). Conclusions: From 2004 to 2020, primary surgery as initial management for non-metastatic anal cancer declined substantially, consistent with increasing adoption of CRT, while overall survival improved over time. Persistent use of upfront surgery in select subgroups warrants further study to clarify indications and ensure guideline-concordant care. Key words: anal cancer; squamous cell carcinoma; primary surgery; chemoradiation; SEER; overall survival

FAQs

What treatment is considered standard for non-metastatic anal cancer, and when is surgery usually used?

Chemoradiation is the standard curative-intent treatment. Surgery is generally reserved for patients who do not respond or who have persistent or progressive disease after initial therapy.

How did the use of upfront primary surgery change from 2004 to 2020?

Primary surgery decreased from 46.0% in 2004 to 28.7% in 2020, reflecting a shift toward chemoradiation-first management.

Which patient factors were associated with higher odds of receiving primary surgery?

Adjusted analyses showed higher odds among younger patients (<50 vs 60–69), males, and Non-Hispanic Black patients compared with Non-Hispanic White patients.

Sep 22, 2026

Upload by Putri