Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Scientific bureau of the Dutch Institute of Clinical Auditing, Leiden, The Netherlands.
Colorectal Dis. 2020 Apr;22(4):416-429. doi: 10.1111/codi.14903. Epub 2019 Nov 27.
This study aimed to determine predictive factors for the circumferential resection margin (CRM) within two northern European countries with supposed similarity in providing rectal cancer care.
Data for all patients undergoing rectal resection for clinical tumour node metastasis (TNM) stage I-III rectal cancer were extracted from the Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit (2011-2015). Separate analyses were performed for cT1-3 and cT4 stage. Predictive factors for the CRM were determined using univariable and multivariable logistic regression analyses.
A total of 6444 Swedish and 12 089 Dutch patients were analysed. Over time the number of hospitals treating rectal cancer decreased from 52 to 42 in Sweden, and 82 to 79 in the Netherlands. In the Swedish population, proportions of cT4 stage (17% vs 8%), multivisceral resection (14% vs 7%) and abdominoperineal excision (APR) (37% vs 31%) were higher. The overall proportion of patients with a positive CRM (CRM+) was 7.8% in Sweden and 5.4% in the Netherlands. In both populations with cT1-3 stage disease, common independent risk factors for CRM+ were cT3, APR and multivisceral resection. No common risk factors for CRM+ in cT4 stage disease were found. An independent impact of hospital volume on CRM+ could be demonstrated for the cT1-3 Dutch population.
Within two northern European countries with implemented clinical auditing, rectal cancer care might potentially be improved by further optimizing the treatment of distal and locally advanced rectal cancer.
本研究旨在确定两个北欧国家直肠癌治疗中环形切缘（CRM）的预测因素。
从瑞典结直肠癌症登记处和荷兰结直肠审计（2011-2015 年）中提取所有接受临床肿瘤淋巴结转移（TNM）分期 I-III 期直肠癌直肠切除术的患者数据。分别对 cT1-3 和 cT4 期进行分析。使用单变量和多变量逻辑回归分析确定 CRM 的预测因素。
共分析了 6444 名瑞典患者和 12 089 名荷兰患者。随着时间的推移，治疗直肠癌的医院数量从瑞典的 52 家减少到 42 家，荷兰从 82 家减少到 79 家。在瑞典人群中，cT4 期（17%比 8%）、多脏器切除（14%比 7%）和腹会阴联合切除术（APR）（37%比 31%）的比例较高。瑞典患者总体 CRM+（CRM+）的比例为 7.8%，荷兰为 5.4%。在两个 cT1-3 期疾病的人群中，CRM+的共同独立危险因素是 cT3、APR 和多脏器切除。在 cT4 期疾病中，未发现 CRM+的共同危险因素。在 cT1-3 期荷兰人群中，独立的医院容量对 CRM+有影响。
在两个实施临床审计的北欧国家，通过进一步优化远端和局部进展期直肠癌的治疗，直肠癌治疗可能会得到改善。
