Patterns of Recurrence and Epidemiological Features of Anal Canal Squamous Cell Carcinoma: An Institutional Cohort Analysis

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All articles of this category (opens in new window) Address for correspondence Artur Licio Junior (arturliciojr@gmail.com) Background: Anal canal squamous cell carcinoma (SCC) is rare, representing ~2% of gastrointestinal cancers. Although CRT achieves high local control, 20–35% of patients recur. Understanding clinicopathological factors linked to recurrence patterns may optimize surveillance and treatment. Objectives: To describe the clinical profile of patients with anal canal SCC and assess recurrence patterns and their prognostic impact. Methods: We retrospectively analyzed 51 patients with histologically confirmed SCC of the anal canal who experienced recurrence after curative-intent CRT at a tertiary center, with or without salvage surgery. Patients were classified by recurrence pattern: local, distant, or both. Associations with baseline features, AJCC 8th stage, RT technique, chemotherapy regimen, and timing of complete response (CR) were assessed using chi-square. OS was estimated via Kaplan-Meier and adjusted using a multivariable Cox model (p < 0.05 as significant). Results: Among 51 patients, 20 (39.2%) relapsed locally, 20 (39.2%) distantly, and 11 (21.6%) had both. Median age was 57 years (range: 33–81); 68.6% were female; 23.5% were HIV-positive. IMRT was used in 64.7%, and mitomycin C + 5-FU in 51%. No significant associations were found between recurrence pattern and gender, HIV status, ECOG, stage, RT technique, chemotherapy regimen, or toxicity. Time to complete response significantly differed across groups (p = 0.029): 55% of patients with distant-only recurrence achieved complete response within 3 months. Local or combined recurrences were associated with delayed or absent CR. Median OS was 41 months for local, 25 months for distant, and intermediate for combined recurrence, though not statistically significant (p = 0.138). In multivariable analysis, higher AJCC stage at diagnosis showed a trend toward worse survival (HR 1.38; 95% CI 0.997–1.92; p = 0.052), and patients with non-regional recurrence had a higher risk of death (HR 2.57; 95% CI 0.92–7.14; p = 0.071). RT toxicity was not independently associated with survival (p = 0.29). Conclusion: Recurrence patterns were not associated with most clinical or treatment factors. However, early CR was more frequent in those who later developed distant failure, and regional relapse correlated with prior surgery. A trend toward worse survival was observed in patients with non-regional recurrence. These findings support individualized follow-up and therapeutic strategies tailored to recurrence risk. Publication History Article published online: 26 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil Bibliographical Record Artur Licio Junior, Beatriz Nelli Barbatto, Lucas Pivetta Genovez, Rachel Simões Pimenta Riechelmann, Marcos Pedro Guedes Camandaroba. Patterns of Recurrence and Epidemiological Features of Anal Canal Squamous Cell Carcinoma: An Institutional Cohort Analysis. Brazilian Journal of Oncology 2026; 22. DOI: 10.1055/s-0046-1825328

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