Buchwald Pamela, Hall Claire, Davidson Callum, Dixon Liane, Dobbs Bruce, Robinson Bridget, Frizelle Frank
Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Department of Oncology, Christchurch Hospital, Christchurch, New Zealand.
ANZ J Surg. 2018 Mar;88(3):E114-E117. doi: 10.1111/ans.13730. Epub 2016 Sep 12.
Colorectal cancer (CRC) is the third most common cancer worldwide. This study was undertaken to evaluate survival outcomes and changes of disease outcomes of CRC patients over the last decades.
A retrospective analysis of CRC patients in Christchurch was performed in four patient cohorts at 5 yearly intervals; 1993-94, 1998-99, 2004-05 and 2009. Data on cancer location, stage, surgical and oncological treatment and survival were collected. Univariate, multivariate and Kaplan-Meier survival analysis were performed.
There were 1391 patients (355, 317, 419 and 300 per cohort), 1037 colon and 354 rectal cancers, respectively. For colon cancer, right-sided cancers appeared more common in later cohorts (P = 0.01). There was a significant decrease in the number of permanent stomas for colon cancer patients (P = 0.001). There was an analogous trend for rectal cancers (P = 0.075). More CRC patients with stage IV disease were treated surgically (P = 0.001) and colon cancer stages I and II tended to have increased survival if operated by a colorectal surgeon (P = 0.06). Oncology referrals have increased remarkably (P = 0.001). Overall 56% of patients were alive at 5 years however rectal cancer patients had significantly better 5-year survival than those with colon cancer (P < 0.05).
This four cohort study shows that modern CRC survival continues to improve and is comparable to international standards. Furthermore, rectal cancer patients have a better 5-year survival than colon cancer patients. The improved survival with early stage colon cancers operated on by specialist colorectal surgeons needs further exploration.
结直肠癌（CRC）是全球第三大常见癌症。本研究旨在评估过去几十年间CRC患者的生存结局及疾病结局变化。
对克赖斯特彻奇的CRC患者进行回顾性分析，分四个患者队列，每隔5年进行一次；分别为1993 - 1994年、1998 - 1999年、2004 - 2005年和2009年。收集癌症位置、分期、手术及肿瘤治疗情况和生存数据。进行单因素、多因素及Kaplan-Meier生存分析。
共有1391例患者（每个队列分别为355例、317例、419例和300例），其中结肠癌1037例，直肠癌354例。对于结肠癌，右侧癌症在后期队列中似乎更为常见（P = 0.01）。结肠癌患者永久性造口的数量显著减少（P = 0.001）。直肠癌也有类似趋势（P = 0.075）。更多IV期疾病的CRC患者接受了手术治疗（P = 0.001），I期和II期结肠癌患者若由结直肠外科医生进行手术，生存倾向于增加（P = 0.06）。肿瘤转诊显著增加（P = 0.001）。总体而言，56%的患者5年后仍存活，然而直肠癌患者的5年生存率显著高于结肠癌患者（P < 0.05）。
这项四队列研究表明，现代CRC生存率持续提高，且与国际标准相当。此外，直肠癌患者的5年生存率高于结肠癌患者。由专科结直肠外科医生进行手术的早期结肠癌患者生存率提高这一情况需要进一步探究。
