Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Clin Colorectal Cancer. 2021 Sep;20(3):187-196. doi: 10.1016/j.clcc.2021.01.002. Epub 2021 Jan 23.
Rectal cancer treatment is often multimodal, comprising of surgery, chemotherapy, and radiotherapy. However, the impact of coordination between these modalities is currently unknown. We aimed to assess whether delivery of nonsurgical therapy within same facility as surgery impacts survival in patients with rectal cancer.
A patient cohort with rectal cancer stages II to IV who received multimodal treatment between 2004 and 2016 from National Cancer Database was retrospectively analyzed. Patients were categorized into three groups: (A) surgery + chemotherapy + radiotherapy at same facility (surgery + 2); (B) surgery + chemotherapy or radiotherapy at same facility (surgery + 1); or (C) only surgery at reporting facility (chemotherapy + radiotherapy elsewhere; surgery + 0). The primary outcome was 5-year overall survival (OS), analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models.
A total of 44,716 patients (16,985 [37.98%] surgery + 2, 12,317 [27.54%] surgery + 1, and 15,414 [34.47%] surgery + 0) were included. In univariate analysis, we observed that surgery+2 patients had significantly greater 5-year OS compared to surgery + 1 or surgery + 0 patients (5-year OS: 63.46% vs 62.50% vs 61.41%, respectively; P= .002). We observed similar results in multivariable Cox proportional-hazards analysis, with surgery + 0 group demonstrating increased hazard of mortality when compared to surgery + 2 group (HR: 1.09; P< .001). These results held true after stratification by stage for stage II (HR 1.10; P= .022) and stage III (HR 1.12; P< .001) but not for stage IV (P= .474).
Greater degree of care coordination within the same facility is associated with greater OS in patients with stage II to III rectal cancer. This finding illustrates the importance of interdisciplinary collaboration in multimodal rectal cancer therapy.
直肠癌的治疗通常是多模式的，包括手术、化疗和放疗。然而，目前尚不清楚这些模式之间的协调会产生什么影响。我们旨在评估在直肠癌患者中，同一机构内提供非手术治疗是否会影响生存。
回顾性分析了 2004 年至 2016 年间国家癌症数据库中接受多模式治疗的 II 至 IV 期直肠癌患者的队列。患者分为三组：(A)同一机构内进行手术+化疗+放疗（手术+2）；(B)同一机构内进行手术+化疗或放疗（手术+1）；或(C)仅在报告机构进行手术（化疗+放疗在其他地方；手术+0）。主要结局是 5 年总生存率（OS），使用 Kaplan-Meier 曲线、对数秩检验和 Cox 比例风险模型进行分析。
共纳入 44716 例患者（手术+2 组 16985 例[37.98%]，手术+1 组 12317 例[27.54%]，手术+0 组 15414 例[34.47%]）。单因素分析显示，手术+2 组患者的 5 年 OS 显著高于手术+1 或手术+0 组（5 年 OS：分别为 63.46%、62.50%和 61.41%；P=.002）。我们在多变量 Cox 比例风险分析中观察到了类似的结果，与手术+2 组相比，手术+0 组的死亡风险增加（HR：1.09；P<.001）。这些结果在 II 期（HR 1.10；P=.022）和 III 期（HR 1.12；P<.001）分层后仍然成立，但在 IV 期（P=.474）则不然。
同一机构内更高程度的护理协调与 II 期至 III 期直肠癌患者的 OS 增加相关。这一发现说明了多模式直肠癌治疗中跨学科合作的重要性。
