Luke C G, Koczwara B, Moore J E, Olver I N, Penniment M G, Pittman K, Price T J, Rieger N A, Roediger B W E, Wattchow D A, Young G P, Roder D M
Epidemiology Branch, Department of Health, South Australia, Australia.
Clin Oncol (R Coll Radiol). 2005 Aug;17(5):372-81. doi: 10.1016/j.clon.2005.04.005.
To evaluate trends in colorectal cancer survival and treatment at South Australian teaching hospitals and degree of adherence to treatment guidelines which recommend adjuvant chemotherapy for Dukes' C colon cancers and combined chemotherapy and radiotherapy for high-risk rectal cancers.
Trends in disease specific survival and primary treatment were analysed, and comparisons drawn between diagnostic epochs, using cancer registry data from South Australian teaching hospitals. Statistical methods included univariate and multivariable disease specific survival analyses.
Five-year survival increased from 48% in 1980-1986 to 56% in 1995-2002. Largest gains were for stage C, where survivals were higher when chemotherapy was part of the primary treatment. By comparison, gains in 1-year survival were largest for stage D. Chemotherapy was provided for 4% of patients with colorectal cancers in 1980-1986, increasing to 32% in 1995-2002. Among stage C cases below 70 years at diagnosis, the proportion having chemotherapy increased to 83% in 1995-2002. The most common chemotherapy was fluorouracil (5FU) as a single agent in 1980-1986 and 5FU with leucovorin in 1995-2002. As expected, radiotherapy was used more frequently for rectal than colon cancers, and particularly for stage C. Among stage C rectal cases below 70 years, the proportion having radiotherapy increased from 10% in 1980-1986 to 57% in 1995-2002. Approximately 93% of colorectal cancers were treated surgically. Patients not treated surgically tended to be aged 80 years or more and to present with distant metastases.
Trends in chemotherapy and radiotherapy accord with evidence-based recommendations. There have been reassuring gains in survivals after adjusting for stage, grade and other prognostic indicators. The data show survival gains and treatment patterns that individual hospitals can use as benchmarks when evaluating their own experience.
评估南澳大利亚教学医院结直肠癌的生存和治疗趋势，以及对治疗指南的遵循程度，该指南推荐对Dukes' C期结肠癌进行辅助化疗，对高危直肠癌进行化疗联合放疗。
利用南澳大利亚教学医院的癌症登记数据，分析疾病特异性生存和初始治疗的趋势，并对不同诊断时期进行比较。统计方法包括单变量和多变量疾病特异性生存分析。
五年生存率从1980 - 1986年的48%提高到1995 - 2002年的56%。C期的生存率提高幅度最大，当化疗作为初始治疗的一部分时，生存率更高。相比之下，D期的1年生存率提高幅度最大。1980 - 1986年，4%的结直肠癌患者接受了化疗，到1995 - 2002年这一比例增至32%。在诊断时年龄低于70岁的C期病例中，1995 - 2002年接受化疗的比例增至83%。最常用的化疗药物在1980 - 1986年是氟尿嘧啶（5FU）单药，在1995 - 2002年是5FU联合亚叶酸钙。正如预期的那样，直肠癌放疗的使用频率高于结肠癌，尤其是C期。在诊断时年龄低于70岁的C期直肠癌病例中，接受放疗的比例从1980 - 1986年的10%增至1995 - 2002年的57%。约93%的结直肠癌接受了手术治疗。未接受手术治疗的患者往往年龄在80岁及以上，且伴有远处转移。
化疗和放疗趋势符合循证医学建议。在调整分期、分级和其他预后指标后，生存率有了令人欣慰的提高。数据显示了生存率的提高和治疗模式，各医院在评估自身经验时可将其作为基准。
