Wiegering Armin, Isbert Christoph, Dietz Ulrich A, Kunzmann Volker, Ackermann Sabine, Kerscher Alexander, Maeder Uwe, Flentje Michael, Schlegel Nicolas, Reibetanz Joachim, Germer Christoph-Thomas, Klein Ingo
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr, 2, 97080 Wuerzburg, Germany.
BMC Cancer. 2014 Nov 6;14:816. doi: 10.1186/1471-2407-14-816.
The management of rectal cancer (RC) has substantially changed over the last decades with the implementation of neoadjuvant chemoradiotherapy, adjuvant therapy and improved surgery such as total mesorectal excision (TME). It remains unclear in which way these approaches overall influenced the rate of local recurrence and overall survival.
Clinical, histological and survival data of 658 out of 662 consecutive patients with RC were analyzed for treatment and prognostic factors from a prospectively expanded single-institutional database. Findings were then stratified according to time of diagnosis in patient groups treated between 1993 and 2001 and 2002 and 2010.
The study population included 658 consecutive patients with rectal cancer between 1993 and 2010. Follow up data was available for 99.6% of all 662 treated patients. During the time period between 2002 and 2010 significantly more patients underwent neoadjuvant chemoradiotherapy (17.6% vs. 60%) and adjuvant chemotherapy (37.9% vs. 58.4%). Also, the rate of reported TME during surgery increased. The rate of local or distant metastasis decreased over time, and tumor related 5-year survival increased significantly with from 60% to 79%.
In our study population, the implementation of treatment changes over the last decade improved the patient's outcome significantly. Improvements were most evident for UICC stage III rectal cancer.
在过去几十年中，随着新辅助放化疗、辅助治疗以及诸如全直肠系膜切除术（TME）等改良手术的实施，直肠癌（RC）的治疗方式发生了重大变化。目前尚不清楚这些方法总体上是以何种方式影响局部复发率和总生存率的。
从一个前瞻性扩展的单机构数据库中分析了662例连续直肠癌患者中658例的临床、组织学和生存数据，以确定治疗和预后因素。然后根据诊断时间将结果分为1993年至2001年以及2002年至2010年治疗的患者组。
研究人群包括1993年至2010年间658例连续的直肠癌患者。662例接受治疗的患者中，99.6%有随访数据。在2002年至2010年期间，接受新辅助放化疗的患者显著增多（17.6%对60%），接受辅助化疗的患者也显著增多（37.9%对58.4%）。此外，手术中报告的TME率有所增加。局部或远处转移率随时间下降，肿瘤相关的5年生存率从60%显著提高到79%。
在我们的研究人群中，过去十年治疗方式的改变显著改善了患者的预后。对于国际抗癌联盟（UICC）III期直肠癌，改善最为明显。
