Department of Research, Comprehensive Cancer Centre North East, Enschede/Groningen, The Netherlands.
Eur J Cancer. 2010 May;46(8):1421-9. doi: 10.1016/j.ejca.2010.01.025. Epub 2010 Feb 19.
Since the 1990s, treatment of patients with rectal cancer has changed in the Netherlands. Aim of this study was to describe these changes in treatment over time and to evaluate their effects on survival.
All patients in the Netherlands Cancer Registry with invasive primary rectal cancer diagnosed during the period 1989-2006 were selected. The Cochran-Armitage trend test was used to analyse trends in treatment over time. Multivariate relative survival analyses were performed to estimate relative excess risk (RER) of dying.
In total, 40,888 patients were diagnosed with rectal cancer during the period 1989-2006. The proportion of patients with stages II and III disease receiving preoperative radiotherapy increased from 1% in the period 1989-1992 to 68% in the period 2004-2006 for younger patients (<75 years) and from 1% to 51% for older patients (>or=75 years), whereas the use of postoperative radiotherapy decreased. Administration of chemotherapy to patients with stage IV disease increased over time from 21% to 66% for patients younger than 75 years. Both males and females exhibited an increase in five-year relative survival from 53% to 60%. The highest increase in survival was found for patients with stage III disease. In the multivariate analyses survival improved over time for patients with stages II-IV disease. After adjustment for treatment variables, this improvement remained significant for patients with stages III and IV disease.
The changes in therapy for rectal cancer have led to a markedly increased survival. Patients with stage III disease experienced the greatest improvement in survival.
自 20 世纪 90 年代以来，荷兰直肠癌患者的治疗方式发生了变化。本研究旨在描述这些治疗方式随时间的变化，并评估其对生存率的影响。
从荷兰癌症登记处中选择 1989 年至 2006 年间诊断为侵袭性原发性直肠癌的所有患者。采用 Cochran-Armitage 趋势检验分析随时间变化的治疗趋势。采用多变量相对生存分析来估计死亡的相对超额风险（RER）。
1989 年至 2006 年间，共有 40888 例患者被诊断为直肠癌。在年轻患者（<75 岁）中，接受术前放疗的 II 期和 III 期疾病患者比例从 1989 年至 1992 年的 1%增加到 2004 年至 2006 年的 68%，而接受术后放疗的患者比例从 1%下降到 51%；对于老年患者（>75 岁），接受术前放疗的患者比例从 1%增加到 44%，接受术后放疗的患者比例从 5%增加到 37%。接受 IV 期疾病化疗的患者比例随时间增加，在年龄<75 岁的患者中从 21%增加到 66%。男性和女性的五年相对生存率均从 53%增加到 60%。III 期疾病患者的生存改善最为显著。在多变量分析中，II-IV 期疾病患者的生存率随时间推移而提高。调整治疗变量后，III 期和 IV 期疾病患者的生存改善仍然显著。
直肠癌治疗方式的变化导致生存率显著提高。III 期疾病患者的生存改善最大。
