{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:10:54Z","timestamp":1780571454241,"version":"3.54.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T00:00:00Z","timestamp":1776556800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anal cancer incidence is rising in the United States, now exceeding 10\u2009000 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\u2009weeks before considering surgery. However, contemporary population-level patterns of upfront primary surgery and associated survival trends remain incompletely described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Armitage), factors associated with primary surgery (multivariable logistic regression), and survival over time (Kaplan\u2013Meier; multivariable Cox proportional hazards modeling).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 16\u2009718 patients with non-metastatic anal cancer, 33.1% (n\u2009=\u20095529) underwent primary surgery and 83.7% (n\u2009=\u200913\u2009997) received radiation as part of initial management. Primary surgery declined from 46.0% in 2004 to 28.7% in 2020 (trend P\u2009&amp;lt;\u20090.001), while radiation utilization was relatively stable over time (trend P\u2009=\u20090.106). In adjusted analyses, younger age (&amp;lt;50 vs 60-69\u2009years; 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 (log-rank P\u2009=\u20090.0002); in adjusted Cox models, diagnosis in 2016-2020 (vs 2004-2007) was associated with lower mortality risk (HR 0.77).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag148","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:39:18Z","timestamp":1776253158000},"source":"Crossref","is-referenced-by-count":0,"title":["Trends in primary surgery and overall survival in non-metastatic anal cancer: a population-based analysis"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5680-3134","authenticated-orcid":false,"given":"Chan","family":"Shen","sequence":"first","affiliation":[{"name":"College of Medicine, Departments of Surgery and Public Health Sciences, Pennsylvania State University , Hershey, PA 17033,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Conces","sequence":"additional","affiliation":[{"name":"University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, OH 44106,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Ciombor","sequence":"additional","affiliation":[{"name":"Division Hematology and Oncology, Vanderbilt-Ingram Cancer Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dorth","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center , Cleveland, OH 44106,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua E","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Fox Chase Cancer Center , Philadelphia, PA 19111,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M","family":"Geiger","sequence":"additional","affiliation":[{"name":"Section of Colon and Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimal","family":"Khan","sequence":"additional","affiliation":[{"name":"Section of Colon and Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeneth","family":"Aquino","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie A","family":"Lockney","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Bapsi","family":"Chakravarthy","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3435-2464","authenticated-orcid":false,"given":"Jennifer","family":"Whisenant","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al B","family":"Benson","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago, IL 60611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-0612","authenticated-orcid":false,"given":"Cathy","family":"Eng","sequence":"additional","affiliation":[{"name":"Division Hematology and Oncology, Vanderbilt-Ingram Cancer Center , Nashville, TN 37232,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2026060406352493000_oyag148-B1","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/jnci\/djz219","article-title":"Recent trends in squamous cell carcinoma of the anus incidence and mortality in the United States, 2001\u20132015","volume":"112","author":"Deshmukh","year":"2020","journal-title":"J Natl Cancer Inst"},{"key":"2026060406352493000_oyag148-B2","author":"National Cancer Institute: Surveillance Epidemiology, and End Results Program","year":"2025"},{"key":"2026060406352493000_oyag148-B3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/CEJ.0000000000000842","article-title":"Global trends in anal cancer incidence and mortality","volume":"33","author":"Mignozzi","year":"2024","journal-title":"Eur J Cancer Prev"},{"key":"2026060406352493000_oyag148-B4","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1097\/QAD.0000000000002218","article-title":"Incidence and time trends of anal cancer among people living with HIV in Australia","volume":"33","author":"Jin","year":"2019","journal-title":"AIDS"},{"key":"2026060406352493000_oyag148-B5","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1056\/NEJM199711063371904","article-title":"Sexually transmitted infection as a cause of anal cancer","volume":"337","author":"Frisch","year":"1997","journal-title":"N Engl J Med"},{"key":"2026060406352493000_oyag148-B6","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1002\/ijc.24215","article-title":"Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions","volume":"124","author":"Hoots","year":"2009","journal-title":"Int J Cancer"},{"key":"2026060406352493000_oyag148-B7","doi-asserted-by":"crossref","first-page":"4344","DOI":"10.1200\/JCO.2012.43.8085","article-title":"Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil\/mitomycin versus fluorouracil\/cisplatin","volume":"30","author":"Gunderson","year":"2012","journal-title":"J Clin Oncol"},{"key":"2026060406352493000_oyag148-B8","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/S1470-2045(13)70086-X","article-title":"Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2\u00d7 2 factorial trial","volume":"14","author":"James","year":"2013","journal-title":"Lancet Oncol"},{"key":"2026060406352493000_oyag148-B9","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/S0140-6736(96)03409-5","article-title":"Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin","volume":"348","author":"Party","year":"1996","journal-title":"Lancet"},{"key":"2026060406352493000_oyag148-B10","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1038\/sj.bjc.6605605","article-title":"Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I)","volume":"102","author":"Northover","year":"2010","journal-title":"Br J Cancer"},{"key":"2026060406352493000_oyag148-B11","author":"National Cancer Institute: Surveillance Epidemiology, and End Results Program","year":"2024"},{"key":"2026060406352493000_oyag148-B12","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1002\/bjs.4908","article-title":"Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer","volume":"92","author":"Renehan","year":"2005","journal-title":"J Br Surg"},{"key":"2026060406352493000_oyag148-B13","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.amjsurg.2011.01.015","article-title":"Outcomes of salvage surgery for epidermoid carcinoma of the anus following failed combined modality treatment","volume":"201","author":"Eeson","year":"2011","journal-title":"Am J Surg"},{"key":"2026060406352493000_oyag148-B14","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1245\/s10434-018-6483-9","article-title":"Salvage abdominoperineal resection for squamous cell anal cancer: a 30-year single-institution experience","volume":"25","author":"Hagemans","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"2026060406352493000_oyag148-B15","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1007\/s10350-008-9361-x","article-title":"Abdominoperineal resection for anal cancer","volume":"51","author":"Mariani","year":"2008","journal-title":"Dis Colon Rectum"},{"key":"2026060406352493000_oyag148-B16","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00384-017-2794-8","article-title":"Long-standing Crohn\u2019s disease and its implication on anal squamous cell cancer management","volume":"32","author":"Lightner","year":"2017","journal-title":"Int J Colorectal Dis"},{"key":"2026060406352493000_oyag148-B17","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s12876-021-01751-3","article-title":"Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn\u2019s disease","volume":"21","author":"Kuroki","year":"2021","journal-title":"BMC Gastroenterol"}],"container-title":["The Oncologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/oncolo\/advance-article-pdf\/doi\/10.1093\/oncolo\/oyag148\/68111259\/oyag148.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/31\/6\/oyag148\/68111259\/oyag148.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/31\/6\/oyag148\/68111259\/oyag148.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:35:37Z","timestamp":1780569337000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oncolo\/article\/doi\/10.1093\/oncolo\/oyag148\/8658825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5,8]]}},"URL":"https:\/\/doi.org\/10.1093\/oncolo\/oyag148","relation":{},"ISSN":["1083-7159","1549-490X"],"issn-type":[{"value":"1083-7159","type":"print"},{"value":"1549-490X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,4,17]]},"article-number":"oyag148"}}