Kulaylat Audrey S, Rivet Emily B, Hollenbeak Christopher S, Stewart David B
Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia; Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
J Surg Res. 2017 Oct;218:1-8. doi: 10.1016/j.jss.2017.05.038. Epub 2017 May 15.
Palliative care is associated with decreased cost and improved quality of life, although its use in stage IV rectal cancer is understudied.
Stage IV rectal cancer patients (2004-2011) who did not undergo surgery with curative intent were identified within the National Cancer Database. Patients receiving palliative therapy were stratified by the type of intervention, as were patients undergoing chemotherapy that was not designated as palliative. Logistic regression was used to identify factors associated with the receipt of palliative therapy.
A total of 11,245 patients were analyzed, of which 2314 (20.6%) received palliative therapy. Use of palliative therapy as a category of treatments did not change significantly from 2004-2012 (19.4%-23.0%; P = 0.14), but the use of palliative chemotherapy nearly doubled (4.7%-8.7%; P < 0.001). Factors associated with the use of palliative therapy included age >60 y and increasing chronic comorbidities; these subgroups also had lower odds of receiving chemotherapy that was not designated as palliative. Differences in gender and race were not associated with variations in the receipt of palliative therapy.
For stage IV rectal cancers managed without curative intent, use of palliative therapies remains consistently low, with a preference for sicker patients.
姑息治疗与成本降低及生活质量改善相关，尽管其在IV期直肠癌中的应用研究不足。
在国家癌症数据库中识别出2004 - 2011年未接受根治性手术的IV期直肠癌患者。接受姑息治疗的患者按干预类型分层，未被指定为姑息治疗的化疗患者也同样分层。采用逻辑回归分析确定与接受姑息治疗相关的因素。
共分析了11245例患者，其中2314例（20.6%）接受了姑息治疗。2004 - 2012年，作为一类治疗方法的姑息治疗使用率无显著变化（19.4% - 23.0%；P = 0.14），但姑息化疗的使用率几乎翻了一番（4.7% - 8.7%；P < 0.001）。与使用姑息治疗相关的因素包括年龄>60岁和慢性合并症增加；这些亚组接受未被指定为姑息治疗的化疗的几率也较低。性别和种族差异与接受姑息治疗的差异无关。
对于未进行根治性治疗的IV期直肠癌，姑息治疗的使用率一直较低，且更倾向于病情较重的患者。
