模式的护理放射治疗的患者与第四期直肠癌：监测，流行病学和结果分析的患者从 2004 年至 2009 年。

Patterns of care of radiation therapy in patients with stage IV rectal cancer: a Surveillance, Epidemiology, and End Results analysis of patients from 2004 to 2009.

机构信息

Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.

出版信息

Cancer. 2014 Mar 1;120(5):731-7. doi: 10.1002/cncr.28467. Epub 2013 Nov 13.

DOI:10.1002/cncr.28467

PMID:24227451

Abstract

BACKGROUND

According to the 2013 National Comprehensive Cancer Network guidelines, pelvic radiation therapy (RT) is one of the preferred regimens for patients with metastatic rectal cancer (mRC). The objective of this study was to analyze patterns of care and outcomes data for the receipt of RT among patients with mRC using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

Patients with stage IV rectal or rectosigmoid cancer were identified in the SEER database (2004-2009). Patients were stratified according to their primary disease site (rectum vs rectosigmoid), tumor (T) classification, and lymph node (N) classification. Treatment regimens (with or without surgical resection, with or without RT) were recorded. The Fisher exact test was used to compare RT rates based on stratified factors. Two and five-year survival rates were compared among treatment groups.

RESULTS

In total, 6873 patients with stage IV rectal cancer and 3417 patients with rectosigmoid cancer were identified. Overall, 20.5% of patients with rectal cancer underwent surgery alone, whereas 38.7% received RT with or without surgery. Within the rectosigmoid group, 51.4% of patients underwent surgery alone, and 15.1% received RT with or without surgery. The use of RT differed significantly between patients with in situ (Tis) through T2 tumors versus T3/T4 tumors (P < .001) and between those with N0 disease versus N1/N2 disease (P < .001). The 2-year and 5-year survival rates differed between treatment groups, with the highest survival rates observed among those who received combined surgery and RT.

CONCLUSIONS

The primary treatments for patients with mRC include RT with or without surgery. RT is used more commonly in patients with primary rectal (vs rectosigmoid) tumors, N0 disease, or Tis-T2 tumors. Treatment with combination surgery and RT is associated with prolonged survival.

摘要

背景

根据 2013 年国家综合癌症网络指南，盆腔放射治疗（RT）是转移性直肠癌（mRC）患者的首选方案之一。本研究的目的是利用监测、流行病学和最终结果（SEER）数据库分析 mRC 患者接受 RT 的治疗模式和结果数据。

方法

在 SEER 数据库中（2004-2009 年）确定了 IV 期直肠或直肠乙状结肠癌患者。根据原发疾病部位（直肠与直肠乙状结肠）、肿瘤（T）分类和淋巴结（N）分类对患者进行分层。记录治疗方案（是否行手术切除，是否行 RT）。采用 Fisher 确切概率法比较分层因素下 RT 率。比较各组之间的 2 年和 5 年生存率。

结果

共确定了 6873 例 IV 期直肠癌患者和 3417 例直肠乙状结肠癌患者。总体而言，20.5%的直肠癌患者仅行手术治疗，38.7%的患者接受了 RT 联合或不联合手术治疗。在直肠乙状结肠组中，51.4%的患者仅行手术治疗，15.1%的患者接受了 RT 联合或不联合手术治疗。T 分期为Tis-T2 肿瘤与 T3/T4 肿瘤（P<0.001）和 N 分期为 N0 与 N1/N2 疾病（P<0.001）的患者 RT 使用情况存在显著差异。不同治疗组的 2 年和 5 年生存率存在差异，接受联合手术和 RT 治疗的患者生存率最高。