局部晚期结直肠癌生存率上升的主要因素：基于监测、流行病学和最终结果（SEER）数据库的分析

The main contributor to the upswing of survival in locally advanced colorectal cancer: an analysis of the SEER database.

作者信息

Li Yuqiang, Zhao Lilan, Güngör Cenap, Tan Fengbo, Zhou Zhongyi, Li Chenglong, Song Xiangping, Wang Dan, Pei Qian, Liu Wenxue

机构信息

Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.

Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Therap Adv Gastroenterol. 2019 Jul 18;12:1756284819862154. doi: 10.1177/1756284819862154. eCollection 2019.

BACKGROUND

There is no conclusion about the most important contributor to the upswing of locally advanced colorectal cancer (LACRC) survival.

METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER) database was extracted to identify colorectal adenocarcinoma cancer patients at stage II and III diagnosed in the two periods 1989-1990 and 2009-2010. The statistical methods included Pearson's chi-squared test, log-rank test, Cox regression model and propensity score matching.

RESULTS

The Cox regression model showed that hazard ratio (HR) of non-surgery dropped from 11.529 to 3.469 in right colon cancer (RCC), 5.214 to 2.652 in left colon cancer (LCC) and 3.275 to 3.269 in rectal cancer (RC) from 1989-1990 to 2009-2010. The 95% confidence intervals (CIs) for surgical resection in 2009-2010 were narrower than those in 1989-1990. HR became greater in LACRC without chemotherapy (from 1.337 to 1.779 in RCC, 1.269 to 2.017 in LCC, 1.317 to 1.811 in RC). There was no overlapping about the 95% CI of chemotherapy between the two groups. The progress of surgery was not linked to the improvement of overall survival (OS) of RCC ( = 0.303) and RC ( = 0.660). Chemotherapy had a significant association with OS of all colorectal cancer (CRC) patients ( = 0.017 in RCC; = 0.006 in LCC; = 0.001 in RC).

CONCLUSIONS

Advancements in chemotherapy regimen were the main contributor to the upswing of CRC survival. The improvements in surgery had a limited effect on improvements in CRC survival.

背景

关于局部晚期结直肠癌（LACRC）生存率上升的最重要因素尚无定论。

方法

提取监测、流行病学和最终结果（SEER）数据库中的数据，以识别在1989 - 1990年和2009 - 2010年这两个时期诊断为II期和III期的结肠腺癌患者。统计方法包括Pearson卡方检验、对数秩检验、Cox回归模型和倾向得分匹配。

结果

Cox回归模型显示，从1989 - 1990年到2009 - 2010年，右结肠癌（RCC）非手术的风险比（HR）从11.529降至3.469，左结肠癌（LCC）从5.214降至2.652，直肠癌（RC）从3.275降至3.269。2009 - 2010年手术切除的95%置信区间（CI）比1989 - 1990年更窄。未接受化疗的LACRC中HR升高（RCC从1.337升至1.779，LCC从1.269升至2.017，RC从1.317升至1.811）。两组化疗的95%CI没有重叠。手术进展与RCC（=0.303）和RC（=0.660）的总生存期（OS）改善无关。化疗与所有结直肠癌（CRC）患者的OS有显著关联（RCC中=0.017；LCC中=0.006；RC中=0.001）。