Finn-Faivre C, Maurel J, Benhamiche A M, Herbert C, Mitry E, Launoy G, Faivre J
Registre Bourguignon des Cancers Digestifs (INSERM CRI 95 05), Faculté de Medecine, Dijon, France.
Gut. 1999 Mar;44(3):377-81. doi: 10.1136/gut.44.3.377.
Over the past 20 years there have been many changes in the management of rectal cancer. Their impact on the overall population is not well known.
To determine trends in management and prognosis of rectal cancer in two French regions.
1978 patients with a rectal carcinoma diagnosed between 1978 and 1993.
Time trends in treatment, stage at diagnosis, operative mortality, and survival were studied on a four year basis. A non-conditional logistic regression was performed to obtain an odds ratio for each period adjusted for the other variables. To estimate the independent effect of the period a multivariate relative survival analysis was performed.
Over the 16 year period resection rates increased from 66.0% to 80.1%; the increase was particularly noticeable for sphincter saving procedures (+30.6% per four years, p=0.03). The percentage of patients receiving adjuvant radiotherapy increased from 24.0% to 40.0% (p=0.02). The proportion of patients with Dukes' type A cancer increased from 17. 7% to 30.6% with a corresponding decrease in those with more advanced disease. Operative mortality decreased by 31.1% per four years (p=0.03). All these improvements have resulted in a dramatic increase in relative survival (from 35.4% for the 1978-1981 period to 57.0% for the 1985-1989 period).
Substantial advances in the management of rectal cancer have been achieved, but there is evidence that further improvements can be made in order to increase survival.
在过去20年里，直肠癌的治疗发生了许多变化。其对总体人群的影响尚不清楚。
确定法国两个地区直肠癌的治疗趋势和预后。
1978例在1978年至1993年间诊断为直肠癌的患者。
以四年为基础研究治疗、诊断分期、手术死亡率和生存率的时间趋势。进行非条件逻辑回归以获得每个时期经其他变量调整后的比值比。为估计时期的独立效应，进行多变量相对生存分析。
在这16年期间，切除率从66.0%提高到80.1%；保肛手术的增加尤为显著（每四年增加30.6%，p = 0.03）。接受辅助放疗的患者比例从24.0%增加到40.0%（p = 0.02）。杜克A期癌症患者的比例从17.7%增加到30.6%，同时病情较晚期的患者比例相应下降。手术死亡率每四年下降31.1%（p = 0.03）。所有这些改善都导致相对生存率显著提高（从1978 - 1981年期间的35.4%提高到1985 - 1989年期间的57.0%）。
直肠癌治疗已取得显著进展，但有证据表明，为提高生存率还可进一步改善。
