Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Colorectal Dis. 2012 Oct;14(10):e668-78. doi: 10.1111/j.1463-1318.2012.03089.x.
The purpose of the present national study was to determine whether improved local control has been accompanied by a change in the incidence of metastases.
The data were from a national population-based rectal cancer registry and included all 6501 rectal cancer patients treated for cure. The study periods were 1993-1997, 1998-2000, 2001-2003 and 2004-2006.
Major changes in the handling of rectal cancer from the first to the last study period included an increased use of MRI from zero to 81% and the use of preoperative radiotherapy from 5% to 20%. The proportion of patients with circumferential resection margin (CRM) ≤2mm decreased from 23% to 13%. The 4-year rate of local recurrence decreased from 13% to 8% (P<0.001), the overall survival increased from 65% to 73% (P<0.001) and the incidence of distant metastases decreased from 25% to 19% (P<0.001) from the first to the last period. The risk of metastases decreased by 29% (hazard ratio 0.71, 95% CI 0.60-0.84).
Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.
本全国性研究旨在确定局部控制的改善是否伴随着转移发生率的变化。
数据来自全国直肠癌注册数据库，包括所有 6501 例接受治愈性治疗的直肠癌患者。研究期间为 1993-1997 年、1998-2000 年、2001-2003 年和 2004-2006 年。
从第一个研究期到最后一个研究期，直肠癌处理方式的主要变化包括 MRI 的使用率从 0 增加到 81%，术前放疗的使用率从 5%增加到 20%。环周切缘（CRM）≤2mm 的患者比例从 23%降至 13%。局部复发的 4 年发生率从 13%降至 8%（P<0.001），总生存率从 65%升至 73%（P<0.001），远处转移发生率从 25%降至 19%（P<0.001）。远处转移的风险降低了 29%（风险比 0.71，95%CI 0.60-0.84）。
旨在改善局部控制和生存的直肠癌诊断和治疗方法的改进，导致远处转移发生率显著降低。
