1Department of Epidemiology, Biostatistics, and Population Medicine, School of Public Health, Loma Linda University, Loma Linda, California 2Department of Surgery, Mutual Aid Association of Public School Teachers, Kinki Central Hospital, Hyogo, Japan 3Region 5 of the California Cancer Registry, Desert Sierra Cancer Surveillance Program, Loma Linda, California 4Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, California.
Dis Colon Rectum. 2013 Dec;56(12):1357-65. doi: 10.1097/01.dcr.0000436362.81611.de.
Perioperative chemoradiotherapy is being used for the treatment of locally advanced rectal cancer to improve survival and reduce recurrence. Although several studies have prompted these changes, the survival benefits of additional chemoradiotherapy have not been adequately tested in a large-scale, population-based setting.
The purpose of this study was to evaluate survival differences between perioperative chemoradiotherapy and surgery alone for the treatment of rectal cancer.
: This was a nonconcurrent cohort study of patients treated for rectal cancer stages II and III between 1994 and 2009.
The study was conducted through the California Cancer Registry.
Eligible patients were those with rectal cancer stage II or III who received either radical surgery alone (N = 2988) or perioperative chemoradiotherapy (N = 8852) during the study period.
Cox proportional hazards regression was used to assess the risk of mortality associated with perioperative chemoradiotherapy versus surgery alone, adjusting for age, sex, race/ethnicity, socioeconomic status, tumor stage, month/year of surgery, and hospital factors.
In multivariable binomial log-linear regression, the adjusted prevalence ratio (PR) for receiving perioperative chemoradiotherapy was lower among patients in the older age groups, especially among those ≥75 years of age (PR = 0.52 [95% CI, 0.49-0.55]), and increased monotonically from lowest (PR = 0.92 [95% CI, 0.89-0.95]) to highest socioeconomic status group (referent). Multivariable Cox proportional hazards regression analysis, adjusting for demographic factors, tumor stage, and hospital identification number, showed that perioperative chemoradiotherapy, relative to surgery alone, was associated with lower mortality during the entire study period, with survival benefit increasing over time (1994-1997: HR = 0.76 [95% CI, 0.66-0.88]; 1998-2001: HR = 0.71 [95% CI, 0.64-0.79]; 2002-2005: HR = 0.63 [95% CI, 0.55-0.71]; 2006-2008: HR = 0.47 [95% CI, 0.39-0.56]).
No information was available on comorbidities or specific surgeon factors, which could contribute to survival differences.
Perioperative chemoradiotherapy, compared with surgery alone, was associated with significantly improved survival during the entire study period, with increasing benefit among those treated during the latter years of our studied time period. (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A120).
新辅助放化疗被用于治疗局部晚期直肠癌，以提高生存率并降低复发率。尽管有几项研究提示了这些变化，但在大规模、基于人群的环境中，尚未充分检验新辅助放化疗的生存获益。
本研究旨在评估新辅助放化疗与单纯手术治疗直肠癌的生存差异。
这是一项对 1994 年至 2009 年期间接受治疗的直肠癌Ⅱ期和Ⅲ期患者进行的非同期队列研究。
该研究通过加利福尼亚癌症登记处进行。
符合条件的患者为接受直肠Ⅱ期或Ⅲ期治疗的患者，他们在研究期间接受单纯根治性手术（n=2988）或新辅助放化疗（n=8852）。
采用 Cox 比例风险回归分析评估新辅助放化疗与单纯手术相比与死亡率相关的风险，调整年龄、性别、种族/民族、社会经济地位、肿瘤分期、手术月份/年份和医院因素。
在多变量二项式线性回归中，年龄较大组（尤其是≥75 岁组）接受新辅助放化疗的调整后患病率比值（PR）较低（PR=0.52[95%CI，0.49-0.55]），且从社会经济地位最低组（PR=0.92[95%CI，0.89-0.95]）到最高组呈单调递增。多变量 Cox 比例风险回归分析，调整人口统计学因素、肿瘤分期和医院识别号，显示与单纯手术相比，新辅助放化疗在整个研究期间与死亡率降低相关，且生存获益随时间增加（1994-1997 年：HR=0.76[95%CI，0.66-0.88]；1998-2001 年：HR=0.71[95%CI，0.64-0.79]；2002-2005 年：HR=0.63[95%CI，0.55-0.71]；2006-2008 年：HR=0.47[95%CI，0.39-0.56]）。
没有关于合并症或特定外科医生因素的信息，这些因素可能导致生存差异。
与单纯手术相比，新辅助放化疗与整个研究期间的生存率显著提高相关，在我们研究期间的后期治疗组中获益增加。（见视频，补充数字内容 1，http://links.lww.com/DCR/A120）。
