Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Eur J Surg Oncol. 2019 Apr;45(4):613-619. doi: 10.1016/j.ejso.2018.12.018. Epub 2018 Dec 26.
Clinically staged T1-3 rectal cancer (cT1-3) is generally treated by total mesorectal excision(TME) with or without neoadjuvant therapy and sometimes requires beyond TME-surgery, whereas cT4 rectal cancer often requires both. This study evaluates the outcome of cT1-3 and cT4 rectal cancer according to hospital volume.
Patients undergoing rectal cancer surgery between 2005 and 2013 in the Netherlands were included from the National Cancer Registry. Hospitals were divided into low(1-20), medium(21-50) and high(>50 resections/year) volume for cT1-3 and low(1-4), medium(5-9) and high(≥10 resections/year) volume for cT4 rectal cancer. Cox-proportional hazards model was used for multivariable analysis of overall survival (OS).
A total of 14.050 confirmed cT1-3 patients and 2.104 cT4 patients underwent surgery. In cT1-3 rectal cancer, there was no significant difference in 5-year OS related to high, medium and low hospital volume (70% vs. 69% vs. 69%). In cT4 rectal cancer, treatment in a high volume cT4 hospital was associated with a survival benefit compared to low volume cT4 hospitals (HR 0.81 95%CI 0.67-0.98) adjusted for non-treatment related confounders, but this was not significant after adjustment for neoadjuvant treatment. Patients with cT4-tumours treated in high volume hospitals had a significantly lower age, more synchronous metastases, more patients treated with neoadjuvant therapy and a higher pT-stage.
Hospital volume was not associated with survival in cT1-3 rectal cancer. In cT4 rectal cancer, treatment in high volume cT4 hospitals was associated with improved survival compared to low volume cT4 hospitals, although this association lost statistical significance after correction for neoadjuvant treatment.
临床分期为 T1-3 的直肠肿瘤（cT1-3）一般采用全直肠系膜切除术（TME）联合或不联合新辅助治疗，有时还需要 TME 以外的手术，而 cT4 直肠肿瘤通常需要这两种治疗。本研究根据医院的手术量评估 cT1-3 和 cT4 直肠肿瘤的治疗效果。
从荷兰国家癌症登记处纳入了 2005 年至 2013 年间接受直肠肿瘤手术的患者。将医院分为 cT1-3 低（1-20 例）、中（21-50 例）和高（>50 例/年）手术量，cT4 直肠肿瘤低（1-4 例）、中（5-9 例）和高（≥10 例/年）手术量。采用 Cox 比例风险模型对总生存（OS）进行多变量分析。
共纳入 14050 例确诊的 cT1-3 患者和 2104 例 cT4 患者接受手术治疗。在 cT1-3 直肠肿瘤中，高、中、低手术量医院之间 5 年 OS 无显著差异（70%比 69%比 69%）。在 cT4 直肠肿瘤中，与低手术量 cT4 医院相比，高手术量 cT4 医院的治疗与生存获益相关（调整非治疗相关混杂因素后 HR 0.81，95%CI 0.67-0.98），但在调整新辅助治疗后，这一结果无统计学意义。在高手术量医院治疗的 cT4 肿瘤患者年龄较低、同步转移较多、接受新辅助治疗的患者较多、pT 分期较高。
医院的手术量与 cT1-3 直肠肿瘤的生存率无关。在 cT4 直肠肿瘤中，与低手术量 cT4 医院相比，高手术量 cT4 医院的治疗与生存获益相关，尽管在调整新辅助治疗后，这种相关性失去了统计学意义。
