Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven.
Department of Research, Comprehensive Cancer Centre North East, Enschede/Groningen.
Ann Oncol. 2010 Nov;21(11):2206-2212. doi: 10.1093/annonc/mdq227. Epub 2010 May 3.
We described changes in treatment of colon cancer over time and the impact on survival in The Netherlands in the period 1989-2006.
All 103,744 patients with invasive colon cancer during 1989-2006 in The Netherlands were included. Data were extracted from The Netherlands Cancer Registry. Trends in treatment over time were analysed and multivariable relative survival analysis was carried out.
The administration of adjuvant chemotherapy in stage III patients <75 years increased from 19% in 1989-1993 to 79% in 2004-2006 and from 1% to 19% in stage III patients ≥75 years. Among stage IV patients, resection rates of the primary tumour decreased from 72% to 63%, while chemotherapy administration increased from 23% to 64% in those <75 years. Survival increased from 52% to 58% in males and from 55% to 58% among females. Stage III patients with adjuvant chemotherapy exhibited a relative excess risk of 0.4 (95% confidence interval 0.4-0.4) compared with those without. Among stage IV patients, resection of primary tumour, palliative chemotherapy, and metastasectomy were important prognostic factors.
There were substantial improvements in management and survival of colon cancer from 1989 to 2006. Stage III disease patients with colon cancer experienced the largest improvement in survival, most likely related to the increased administration of adjuvant chemotherapy.
我们描述了荷兰在 1989-2006 年期间结肠癌治疗方式的变化及其对生存率的影响。
纳入了荷兰在 1989-2006 年间所有 103744 例浸润性结肠癌患者。数据从荷兰癌症登记处提取。对随时间推移的治疗趋势进行了分析，并进行了多变量相对生存分析。
<75 岁的 III 期患者辅助化疗的应用率从 1989-1993 年的 19%增加到 2004-2006 年的 79%，而≥75 岁的 III 期患者从 1%增加到 19%。在 IV 期患者中，原发肿瘤切除率从 72%下降到 63%，而<75 岁患者的化疗应用率从 23%增加到 64%。男性生存率从 52%提高到 58%，女性从 55%提高到 58%。与未接受辅助化疗的患者相比，接受辅助化疗的 III 期患者相对风险超额（95%置信区间为 0.4-0.4）。在 IV 期患者中，原发肿瘤切除术、姑息性化疗和转移灶切除术是重要的预后因素。
1989 年至 2006 年期间，结肠癌的治疗和生存率有了显著的提高。III 期结肠癌患者的生存改善最大，这很可能与辅助化疗的应用增加有关。
