Department of Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Surgical Sciences, University of Bergen, Bergen, Norway.
Br J Surg. 2011 May;98(5):716-23. doi: 10.1002/bjs.7426. Epub 2011 Feb 21.
The surgical management of rectal cancer has changed substantially over the past decade. There are limited data on the long-term outcome of implementing systematic management strategies.
Survival of a national cohort of patients treated surgically for colonic and rectal cancer over a 10-year interval was analysed. All 31 158 patients in Norway diagnosed with adenocarcinoma of the colon and rectum between 1994 and 2003 were identified from the Cancer Registry of Norway and the Norwegian Rectal Cancer Registry. Changes in 5-year relative survival were compared by age, stage and tumour location during the early and late years.
The study population included 19 053 patients who had a curative resection. The relative 5-year survival rate significantly improved for both colonic cancer (73·8 versus 78·0 per cent; P < 0·001) and rectal cancer (72·1 versus 79·6 per cent; P < 0·001). The 5-year relative survival was significantly better for rectal than colonic cancer during the late period (P = 0·030). Improved 5-year relative survival was related to better outcomes in patients with positive lymph nodes (67·2 and 62·1 per cent for rectal and colonic cancer respectively; each P < 0·001 versus early period), but not for the subgroup aged over 75 years with lymph node-positive colonic cancer.
In this national cohort, survival after curative surgery for colorectal cancer increased significantly after implementation of national management strategies. Improvements were most evident for rectal cancer and in lymph node-positive disease; they were less substantial for colonic cancer and elderly patients (over 75 years). Strategic treatment changes may be warranted for the latter group.
在过去的十年中，直肠癌的外科治疗发生了重大变化。关于实施系统管理策略的长期结果的数据有限。
分析了在 10 年期间接受手术治疗的结肠和直肠癌患者的全国队列的生存情况。从挪威癌症登记处和挪威直肠登记处确定了 1994 年至 2003 年间诊断为结肠和直肠腺癌的 31158 名挪威患者。通过年龄、分期和肿瘤位置比较早期和晚期 5 年相对生存率的变化。
研究人群包括 19053 名接受根治性切除术的患者。结肠癌（73.8%比 78.0%；P < 0.001）和直肠癌（72.1%比 79.6%；P < 0.001）的 5 年相对生存率均显著提高。晚期直肠癌的 5 年相对生存率明显优于结肠癌（P = 0.030）。5 年相对生存率的改善与阳性淋巴结患者的更好结果相关（直肠癌和结肠癌分别为 67.2%和 62.1%；P < 0.001），但对于年龄在 75 岁以上且淋巴结阳性的结肠癌患者则不然。
在这项全国性队列研究中，在实施国家管理策略后，结直肠癌根治性手术后的生存显著提高。直肠癌和阳性淋巴结疾病的改善最为明显；结肠癌和老年患者（75 岁以上）的改善幅度较小。对于后者，可能需要进行策略性治疗改变。
