Ju Jiun-Ho, Chang Shih-Ching, Wang Huann-Shen, Yang Shung-Haur, Jiang Jen-Kae, Chen Wei-Chone, Lin Tzu-Chen, Wang Feng-Ming, Lin Jen-Kou
Division of Colon and Rectal Surgery, Department of Surgery, National Yang-Ming University, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Int J Colorectal Dis. 2007 Aug;22(8):855-62. doi: 10.1007/s00384-007-0293-z. Epub 2007 Mar 28.
Colorectal cancer (CRC) is the third most common cause of cancer-related death in Taiwan. During the past 20 years, several advances have improved the treatment outcome and quality of life of CRC patients. The purpose of this study was to identify the changes in the clinicopathological features and outcome of CRC over this period.
Based on the computerized database of the Taipei Veterans General Hospital, between January 1981 and December 2000, 5,474 CRC patients were identified and divided into 2 groups based on the date of treatment (1981-1990 and 1991-2000). The clinicopathological features, outcome, and prognostic factors were analyzed and compared.
RESULTS/FINDINGS: The age at onset of cancer was 61 years in the 1980s group and 66 years in the 1990s group. The frequency of rectal tumors decreased from 50% in the 1980s group to 44% in the 1990s group. Tumor, nodes, metastasis (TNM) stage distribution, surgical mortality, and anastomosis leakage were similar in the two groups. However, the 5-year overall survival rate was better in the 1990s group (56%) than that in the 1980s group (50%, P = 0.001). For rectal cancer patients, the local recurrence rate was lower in the 1990s group (6%) than that in the 1980s group (10%, P < 0.01). In stage III CRC, the 5-year overall survival rate was significantly higher in the 1990s group (54%) than that in the 1980s group (48%, P = 0.011). TNM stage was the most important independent prognostic factor for overall and disease-free survivals, followed by differentiation grade, CEA level, and treatment period.
INTERPRETATION/CONCLUSION: Advances in surgical technique and more standard use of chemotherapy have improved CRC outcome.
在台湾，结直肠癌（CRC）是癌症相关死亡的第三大常见原因。在过去20年中，多项进展改善了结直肠癌患者的治疗效果和生活质量。本研究的目的是确定这段时间内结直肠癌的临床病理特征和治疗结果的变化。
基于台北荣民总医院的计算机数据库，在1981年1月至2000年12月期间，共识别出5474例结直肠癌患者，并根据治疗日期（1981 - 1990年和1991 - 2000年）分为两组。对临床病理特征、治疗结果和预后因素进行分析和比较。
结果/发现：20世纪80年代组的癌症发病年龄为61岁，20世纪90年代组为66岁。直肠肿瘤的发生率从20世纪80年代组的50%降至20世纪90年代组的44%。两组的肿瘤、淋巴结、转移（TNM）分期分布、手术死亡率和吻合口漏情况相似。然而，20世纪90年代组的5年总生存率（56%）高于20世纪80年代组（50%，P = 0.001）。对于直肠癌患者，20世纪90年代组的局部复发率（6%）低于20世纪80年代组（10%，P < 0.01）。在III期结直肠癌中，20世纪90年代组的5年总生存率（54%）显著高于20世纪80年代组（48%，P = 0.011）。TNM分期是总生存和无病生存最重要的独立预后因素，其次是分化程度、癌胚抗原（CEA）水平和治疗时期。
解读/结论：手术技术的进步和化疗更规范的应用改善了结直肠癌的治疗结果。
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