Bouvier Anne-Marie, Jooste Valérie, Sanchez-Perez Maria José, Bento Maria José, Rocha Rodrigues Jessica, Marcos-Gragera Rafael, Carmona-Garcia Maria Carmen, Luque-Fernandez Miguel Angel, Minicozzi Pamela, Bouvier Véronique, Innos Kaire, Sant Milena
Digestive cancer registry of Burgundy, Dijon, France; Dijon University Hospital, Dijon, France; INSERM UMR 1231, Dijon, France; University of Burgundy, Dijon, France.
Digestive cancer registry of Burgundy, Dijon, France; Dijon University Hospital, Dijon, France; INSERM UMR 1231, Dijon, France; University of Burgundy, Dijon, France.
Dig Liver Dis. 2021 May;53(5):639-645. doi: 10.1016/j.dld.2021.01.021. Epub 2021 Feb 24.
The management regarding metastatic colorectal cancer throughout Europe is not well known.
To draw a European comparison of the management and prognosis of metastatic colorectal cancers.
Factors associated with chemotherapy administration were identified through logistic regressions. Net survival was estimated and crude probabilities of death related to cancer and other causes using a flexible cumulative hazard model.
Among the 13 227 patients with colorectal cancer diagnosed between 2010 and 2013 in cancer registries from 10 European countries, 3140 were metastatic. 62% of metastatic patients received chemotherapy. Compared to Spain, the related adjusted odds ratios ranged from 0.7 to 4.0 (P<0.001) according to country. The 3-year net survival by country ranged between 16% and 37%. The survival gap between countries diminished from 21% to 10% when adjusting for chemotherapy, age and sex. Geographical differences in the crude probability of death related to cancer were large for patients <70 or ≥80 years at diagnosis.
Heterogeneity in the application of European guidelines partly explain these differences. General health between populations, accessibility to a reference centre, or provision of health care could also be involved. Further population-based studies are warranted to disentangle between these possible explanations.
整个欧洲对于转移性结直肠癌的管理情况尚不为人所知。
对欧洲转移性结直肠癌的管理和预后进行比较。
通过逻辑回归确定与化疗给药相关的因素。使用灵活的累积风险模型估计净生存率以及与癌症和其他原因相关的粗死亡概率。
在2010年至2013年期间于10个欧洲国家癌症登记处诊断出的13227例结直肠癌患者中，3140例为转移性患者。62%的转移性患者接受了化疗。与西班牙相比，根据国家不同，相关调整后的优势比在0.7至4.0之间（P<0.001）。各国的3年净生存率在16%至37%之间。在对化疗、年龄和性别进行调整后，各国之间的生存差距从21%缩小至10%。对于诊断时年龄<70岁或≥80岁的患者，与癌症相关的粗死亡概率存在很大的地理差异。
欧洲指南应用中的异质性部分解释了这些差异。人群之间的总体健康状况、获得参考中心的机会或医疗保健的提供情况也可能有影响。有必要开展进一步的基于人群的研究，以厘清这些可能的解释。
