Enblad P, Adami H O, Bergström R, Glimelius B, Krusemo U, Påhlman L
Department of Surgery, Uppsala University, Akademiska Sjukhuset, Sweden.
J Natl Cancer Inst. 1988 Jun 15;80(8):586-91. doi: 10.1093/jnci/80.8.586.
The survival of 61,769 patients diagnosed as having colorectal cancer in the total Swedish population in 1960-1981 was analyzed. The 5-year relative survival rates during the total period were approximately 40%; patients with colonic carcinoma had a somewhat better prognosis than patients with rectal carcinoma, and men had a generally less favorable prognosis than women. Comparison of patients diagnosed in 1960-1964 and in 1975-1979 showed a slight improvement in survival during the more recent study period, i.e., an improvement rate of 7.0% for both cancer of the colon and cancer of the rectum. The improvement occurred mainly during the first months of follow-up. However, the excess mortality due to colorectal cancer 1-5 years after diagnosis as compared to the expected mortality in the general population remained virtually unaltered. A multivariate analysis in which adjustment was made for the possible confounding variables of sex, age, and site (of colonic carcinoma) gave consistent results. Reduced postoperative mortality was considered to be the most likely major explanation for the temporal trend toward a more favorable prognosis. Thus it seemed that the treatment of colorectal cancer in Sweden during the last two decades has not improved significantly except in terms of reduced postoperative mortality. Thus the challenge of improving survival in patients with colorectal cancer must be given high priority.
对1960年至1981年瑞典总人口中确诊为患有结直肠癌的61769名患者的生存情况进行了分析。整个时期的5年相对生存率约为40%；结肠癌患者的预后略好于直肠癌患者，男性的总体预后通常比女性差。对1960年至1964年以及1975年至1979年确诊的患者进行比较，结果显示在最近的研究期间生存率略有提高，即结肠癌和直肠癌的生存率提高率均为7.0%。这种改善主要发生在随访的头几个月。然而，与普通人群的预期死亡率相比，诊断后1至5年因结直肠癌导致的额外死亡率几乎没有变化。一项对性别、年龄和（结肠癌的）部位等可能的混杂变量进行调整的多变量分析得出了一致的结果。术后死亡率的降低被认为是预后更有利这一时间趋势最可能的主要解释。因此，在过去二十年里，瑞典除了降低术后死亡率外，结直肠癌的治疗似乎没有显著改善。因此，提高结直肠癌患者生存率的挑战必须得到高度重视。
