Brand M, Gaylard P, Ramos J
Department of Surgery, Faculty of Health Sciences, University of Pretoria, South Africa; School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2018 Feb 1;108(2):118-122. doi: 10.7196/SAMJ.2017.v108i2.12338.
Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA.
To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector.
A retrospective review of a private healthcare funder's database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows.
A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively.
SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.
结直肠癌（CRC）是南非第四大常见癌症，也是第六大致命癌症。约25%的患者在原发性结直肠癌诊断时会出现同步转移性疾病。尽管化疗用于该疾病的大多数阶段，但手术切除原发性肿瘤和转移灶仍然是实现治愈或延长生存期最成功的治疗方式。迄今为止，南非尚未发表关于结直肠癌表现和治疗的数据。
确定南非私立医疗保健部门中结直肠癌的表现、总体治疗模式和总生存期。
对一家私立医疗保健资助机构2008年1月1日至2015年12月31日的数据库进行回顾性研究。使用国际疾病分类及相关健康问题统计分类（第10版）（ICD - 10）诊断代码来识别结直肠癌以及肝和/或肺转移性疾病。分配给住院治疗的手术代码用于识别手术治疗类型。化疗通过世界卫生组织药物解剖治疗化学分类系统来识别。确定治疗模式并计算其5年生存率。使用Kaplan - Meier方法估计生存率，并使用Cox比例风险回归进行生存的组间比较。使用适用于Windows的SAS 9.4版进行数据分析。
共有3412例患者纳入研究，其中仅患有结直肠癌的患者2267例，患有肝转移（LM）或肺转移（PM）的患者1145例。平均年龄为64.1岁（范围21 - 97岁），54.6%为男性；这些在研究组之间无统计学差异。20%的肝转移或肺转移患者接受了转移灶的手术切除。仅患有结直肠癌、结直肠癌伴肝转移（CRCLM）、结直肠癌伴肺转移（CRCPM）和结直肠癌伴肝肺转移（CRCLMPM）的所有疾病手术切除后的5年生存率分别为71.7%、57.3%、31.5%和26.0%。
在南非私立医疗保健部门接受治疗的结直肠癌患者与已发表的国际系列中的疾病表现相似，各种治疗途径后的结果也相似；然而，与国际趋势相比，似乎转移灶的切除较少。
