{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:21:04Z","timestamp":1789147264693,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The relationship between macroscopic tumour morphology and clinical outcomes has previously been demonstrated for malignant melanoma and gastric cancers, but not for anal squamous cell cancer (ASCC). This study investigated the effect of the morphology of ASCC on oncological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The morphology of all ASCC patients presenting between 2003 and 2022 was analysed retrospectively and classified as Exophytic, Ulcerated or Mixed. The primary outcome was 5\u2010year overall survival (OS). Secondary outcomes were complete response to treatment, local recurrence (LR) and 5\u2010year disease\u2010free survival (DFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 622 patients referred to the anal MDT, 515 were included for analysis: 290 exophytic, 179 ulcerated and 46 mixed morphology. Ulcerated morphology was associated with a significantly lower percentage of patients surviving at 5\u2009years compared to exophytic and mixed groups (25.1% vs. 67.9% vs. 65.2%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Ulcerated and mixed morphology patients presented with significantly larger tumours (T4\u2010 30.7% vs. 28.3% vs. 10.0%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and greater nodal involvement (N2\u2010 26.3% vs. 17.2% vs. 15.2%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042). Exophytic morphology patients had significantly greater complete response at 95.9%, compared to 82.6% for mixed and 45.8% for ulcerated tumours (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Morphology remained significant in both univariable and multivariable Cox regression models across 5\u2010year OS, DFS and LR. Ulcerated [HR 5.160 (3.338\u20137.979)\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] and mixed morphology [HR 2.299 (1.179\u20134.482)\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015] had significantly worse risk of 5\u2010year overall survival compared to exophytic morphology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ulcerated morphology is associated with advanced tumours, poor response to chemoradiotherapy, resulting in a higher incidence of recurrent disease and worse overall\u2010 and disease\u2010free survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70541","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T04:09:21Z","timestamp":1783310961000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic impact of anal cancer morphology on survival and local recurrence: A 20\u2010year regional cohort study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7359-6640","authenticated-orcid":false,"given":"Alwin","family":"Puthiyakunnel Saji","sequence":"first","affiliation":[{"name":"School of Medicine Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Rackley","sequence":"additional","affiliation":[{"name":"Velindre Cancer Centre  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Horwood","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery University Hospital of Wales  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9830-3832","authenticated-orcid":false,"given":"Rachel","family":"Hargest","sequence":"additional","affiliation":[{"name":"School of Medicine Cardiff University  Cardiff UK"},{"name":"Department of Colorectal Surgery University Hospital of Wales  Cardiff 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