美国 2004-2015 年 II-III 期直肠乙状结肠癌的治疗模式。

Patterns of Care for Stage II-III Rectosigmoid Cancers in the United States, 2004-2015.

机构信息

Departments of Radiation Oncology.

Medical Oncology, University of Texas Southwestern, Dallas, TX.

出版信息

Am J Clin Oncol. 2020 May;43(5):311-318. doi: 10.1097/COC.0000000000000674.

DOI:10.1097/COC.0000000000000674

PMID:32235162

Abstract

OBJECTIVES

Although current guidelines continue to recommend trimodality therapy for stage II to III rectal cancers, a lower incidence of local recurrence has been observed in patients with upper rectal tumors, including those in the rectosigmoid. In practice, patients with upper rectal tumors may not be receiving all 3 modalities of therapy. Patterns of care for patients with rectosigmoid cancers have not previously been described.

METHODS

The National Cancer Database (NCDB) was used to identify patients diagnosed with stage II to III rectosigmoid cancer who underwent definitive surgery between 2004 and 2015. Multivariable logistic regression defined adjusted odds ratio and associated 95% confidence intervals of receipt of any pelvic radiotherapy and preoperative and postoperative pelvic radiotherapy. Multivariable logistic regression also assessed odds of treatment with any chemotherapy and multiagent chemotherapy.

RESULTS

Among 8410 patients, 3566 (42.4%) received any pelvic radiotherapy, of which 2516 (70.6%) were treated with preoperative radiotherapy. Factors associated with receipt of radiotherapy included male sex, white race, younger age, positive clinical nodes and positive margins (P<0.001). Among patients with clinically positive nodes, 1980 (48.6%) received any radiotherapy and among those with pathologically positive nodes, 1532 (37.9%) received radiotherapy. A total of 5708 patients (67.9%) received any chemotherapy including 3020 (52.9%) with multiagent chemotherapy. A total of 2579 (30.7%) of the cohort was treated with surgery alone and among patients who were T3N0, this proportion rose to 42.5%.

CONCLUSIONS

Less than half of patients with stage II to III rectosigmoid cancers are treated with radiation therapy and approximately one third do not receive chemotherapy. Ongoing and future studies may help to better tailor treatment for rectosigmoid tumors to optimize the therapeutic ratio. Our work may serve as a benchmark on which to compare future practice patterns.

摘要

目的

尽管目前的指南继续推荐对 II 期至 III 期直肠癌患者进行三联疗法，但已观察到高位直肠肿瘤（包括直肠乙状结肠交界处的肿瘤）患者局部复发率较低。实际上，高位直肠肿瘤患者可能并未接受所有 3 种治疗方式。此前尚未描述过直肠乙状结肠癌患者的治疗模式。

方法

使用国家癌症数据库（NCDB）确定了 2004 年至 2015 年间接受根治性手术治疗的 II 期至 III 期直肠乙状结肠癌患者。多变量逻辑回归定义了接受任何盆腔放疗以及术前和术后盆腔放疗的调整后优势比及其 95%置信区间。多变量逻辑回归还评估了接受任何化疗和联合化疗的治疗机会。

结果

在 8410 名患者中，有 3566 名（42.4%）接受了任何盆腔放疗，其中 2516 名（70.6%）接受了术前放疗。接受放疗的因素包括男性、白种人、年龄较小、阳性临床淋巴结和阳性切缘（P<0.001）。在有临床阳性淋巴结的患者中，有 1980 名（48.6%）接受了任何放疗，在有病理阳性淋巴结的患者中，有 1532 名（37.9%）接受了放疗。共有 5708 名患者（67.9%）接受了任何化疗，其中 3020 名（52.9%）接受了联合化疗。共有 2579 名（30.7%）患者仅接受了手术治疗，在 T3N0 患者中，这一比例上升至 42.5%。