Shahjehan Faisal, Kasi Pashtoon M, Habermann Elizabeth, Day Courtney N, Colibaseanu Dorin T, Mathis Kellie L, Larson David W, Merchea Amit
Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA.
Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA.
Int J Colorectal Dis. 2019 Feb;34(2):239-245. doi: 10.1007/s00384-018-3171-y. Epub 2018 Oct 2.
Previous studies have shown that sphincter-preserving surgery is associated with better quality of life in postsurgical rectal cancer patients. However, the factors predicting the likelihood of undergoing sphincter-preserving surgery have not been well-described. The aim of this study was to report the factors that determined the likelihood of undergoing sphincter-preserving surgery.
Characteristics of 24,018 rectal cancer patients undergoing sphincter-preserving surgery and abdominoperineal resection diagnosed from 2008 to 2012 from the National Cancer Database were investigated retrospectively for rate, pattern, and differences in mortality. Cox proportional hazards models were used to calculate hazard ratios for assessing mortality. Odds ratios were calculated using logistic regressions models for outcome sphincter-preserving surgery.
Eighteen thousand four hundred fifty-two (77%) patients had sphincter-preserving surgery. Majority of sphincter-preserving surgery patients were aged < 70 (74%), had private insurance (52%), and got treatment at a comprehensive community cancer program (54%). Multivariable analysis showed that patients with age ≥ 70 (OR 0.87, 95% CI 0.80-0.95), male gender (OR 0.90, 95% CI 0.84-0.96), having Medicare (OR 0.83, 95% CI 0.76-0.90), Medicaid (OR 0.72, 95% CI 0.63-0.81), and poorly differentiated grade (OR 0.78, 95% CI 0.71-0.85) were less likely to undergo sphincter-preserving surgery. Multivariable analysis showed that patients having abdominoperineal resection have higher likelihood of mortality than sphincter-preserving surgery (HR 1.26, 95% CI 1.16-1.36).
We were able to identify several patient and tumor-related factors impacting the likelihood of undergoing sphincter-preserving surgery. Patients undergoing non-sphincter sparing surgery had a higher mortality that sphincter preservation.
既往研究表明，保留括约肌手术与术后直肠癌患者更好的生活质量相关。然而，预测接受保留括约肌手术可能性的因素尚未得到充分描述。本研究的目的是报告决定接受保留括约肌手术可能性的因素。
回顾性调查2008年至2012年从国家癌症数据库诊断出的24018例接受保留括约肌手术和腹会阴联合切除术的直肠癌患者的特征，包括发生率、模式和死亡率差异。使用Cox比例风险模型计算风险比以评估死亡率。使用逻辑回归模型计算保留括约肌手术结局的比值比。
18452例（77%）患者接受了保留括约肌手术。大多数接受保留括约肌手术的患者年龄<70岁（74%），有私人保险（52%），并在综合社区癌症项目中接受治疗（54%）。多变量分析显示，年龄≥70岁的患者（比值比0.87，95%置信区间0.80 - 0.95）、男性（比值比0.90，95%置信区间0.84 - 0.96）、有医疗保险（比值比0.83，95%置信区间0.76 - 0.90）、有医疗补助（比值比0.72，95%置信区间0.63 - 0.81）以及低分化分级（比值比0.78，95%置信区间0.71 - 0.85）的患者接受保留括约肌手术的可能性较小。多变量分析显示，接受腹会阴联合切除术的患者比保留括约肌手术的患者死亡可能性更高（风险比1.26，95%置信区间1.16 - 1.36）。
我们能够确定几个影响接受保留括约肌手术可能性的患者和肿瘤相关因素。接受非保留括约肌手术的患者比保留括约肌手术的患者死亡率更高。
