Martijn H, Voogd A C, van de Poll-Franse L V, Repelaer van Driel O J, Rutten H J T, Coebergh J W W
Department of Radiotherapy, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
Eur J Cancer. 2003 Sep;39(14):2073-9. doi: 10.1016/s0959-8049(03)00493-3.
The treatment of rectal cancer has changed over the last two decades as far as surgical techniques and radiotherapy are concerned. We studied the changes in patterns of care for patients with rectal cancer and the effect on prognosis. All patients with cancer of the rectum or rectosigmoid in South-east Netherlands, diagnosed in the period of 1980-2000, were included in our analyses (n=3635). The use of surgery as the only treatment decreased from 62% in the period of 1980-1989 to 42% in the period of 1995-2000, whereas the combination of surgery and radiotherapy increased from 26 to 40%. The use of postoperative radiotherapy decreased from 25 to 4%, while preoperative radiotherapy increased from 1 to 35%. Patients aged 75 years or older were less likely to receive radiotherapy. After adjustment for age, gender, tumour stage and tumour site, significant improvements in the relative risk of death were observed between the periods of 1995-2000 and 1980-1989 for patients under 60 years of age (Relative Risk (RR)=0.45; 95% Confidence Interval (CI)=0.35-0.58) and those 60-74 years old (RR=0.62; 95% CI 0.53-0.72). No improvement in the risk of death was found for patients aged 75 years and over. No improvements in the distribution of tumour stage were observed, making it very likely that the continuing increase in population-based survival among patients aged <75 years results from the shift from postoperative to preoperative radiotherapy, the development of the total mesorectal excision technique and the related tendency to subspecialisation of surgeons in colorectal cancer surgery.
在过去二十年里，就手术技术和放射治疗而言，直肠癌的治疗方法发生了变化。我们研究了直肠癌患者护理模式的变化及其对预后的影响。纳入分析的患者为1980年至2000年期间在荷兰东南部被诊断为直肠癌或直肠乙状结肠癌的所有患者（n = 3635）。仅采用手术治疗的比例从1980 - 1989年期间的62%降至1995 - 2000年期间的42%，而手术与放射治疗联合使用的比例从26%增至40%。术后放疗的使用比例从25%降至4%，而术前放疗从1%增至35%。75岁及以上的患者接受放疗的可能性较小。在对年龄、性别、肿瘤分期和肿瘤部位进行调整后，观察到1995 - 2000年期间与1980 - 1989年期间相比，60岁以下患者（相对风险（RR）= 0.45；95%置信区间（CI）= 0.35 - 0.58）和60 - 74岁患者（RR = 0.62；95% CI 0.53 - 0.72）的死亡相对风险有显著改善。75岁及以上患者的死亡风险没有改善。未观察到肿瘤分期分布的改善，这很可能是由于<75岁患者基于人群的生存率持续提高是源于从术后放疗向术前放疗的转变、全直肠系膜切除技术的发展以及结直肠癌手术中医师亚专业化的相关趋势。
