Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany.
Clin Colorectal Cancer. 2018 Mar;17(1):e129-e142. doi: 10.1016/j.clcc.2017.09.002. Epub 2017 Sep 28.
Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers.
Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders.
A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers.
Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.
新辅助治疗可提高临床试验中 II 期和 III 期直肠癌患者的生存率。在这项研究中，我们调查了荷兰和瑞典 2 个欧洲国家和 3 个专科中心接受新辅助放疗（neo-RT）和新辅助放化疗（neo-CRT）治疗及其与患者术后生存的关系。
评估荷兰和瑞典 neo-RT 治疗的应用和手术后的总生存率。使用 Cox 回归分析调整潜在混杂因素后得出危险比（HR）。
共纳入 16095 例临床 II 期和 III 期直肠腺癌患者进行分析。 neo-RT 和 neo-CRT 的应用存在很大差异。老年患者较少接受 neo-RT 和 neo-CRT。 III 期疾病患者接受 neo-CRT 比 neo-RT 更频繁。与未接受新辅助治疗的手术相比，荷兰（HR，0.62；95%置信区间[CI]，0.53-0.73）和瑞典（HR，0.79；95% CI，0.69-0.90） neo-RT 的应用与生存改善显著相关。在荷兰（HR，0.62；95% CI，0.50-0.78） neo-CRT 的应用与生存改善相关，但在瑞典（HR，0.97；95% CI，0.80-1.18）不相关。 neo-CRT 治疗组患者的死亡率与 neo-RT 治疗组相比，在基于人群的中心的结果不一致。
我们的结果支持 neo-RT 与 II 期和 III 期直肠癌患者的生存改善相关。与 neo-RT 相比， neo-CRT 的应用差异较大，且各中心的生存结果不一致。
