Brand M, Gaylard P, Ramos J
Department of Surgery, University of Pretoria, South Africa and School of Physiology, University of the Witwatersrand, South Africa.
Data Management and Statistical Analysis, South Africa.
S Afr J Surg. 2021 Mar;59(1):2-6.
Approximately 25% of patients with colorectal cancer (CRC) will be diagnosed with CRC liver metastases (CRCLM) during the course of their disease. No data regarding CRCLM presentation, management and survival outcomes has been published from either the private or public health care sectors in South Africa. This study aimed to address this deficit, reporting on a private sector cohort.
A retrospective review of a private health care funder's database from 1 January 2008 to 31 December 2015 was performed. ICD-10 diagnosis codes were used to identify CRC and CRCLM. Procedure codes assigned to hospital admissions were used to identify the type of surgical treatment. Chemotherapy was identified by the WHO Anatomical Therapeutic Chemical classification system of medicines. Treatment patterns were assessed and five-year overall survival (OS) was calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional-hazards regression was used for between group survival comparisons.
Six hundred and one (601) of 3 412 patients presenting with CRC (17.6%) were diagnosed with CRCLM at presentation or during the follow-up period. Sixty patients with CRCLM (10.0%) underwent resection of the primary CRC and liver resection for metastases, 281 (46.8%) underwent CRC resection only, 180 (30%) received chemotherapy only, and 47 (7.8%) received no treatment. Five-year OS for these groups were 57.3%, 15.6%, 9.8% and 0% respectively.
Five-year OS of the various CRCLM treatment pathways in a South African private sector population compares to results published in international series. However, a smaller proportion of patients with CRCLM underwent liver resection, compared to international studies.
约25%的结直肠癌（CRC）患者在疾病过程中会被诊断为结直肠癌肝转移（CRCLM）。南非的私立或公共医疗部门均未发表过关于CRCLM的表现、管理及生存结果的数据。本研究旨在填补这一空白，报告一个私立部门队列的情况。
对一家私立医疗资助机构2008年1月1日至2015年12月31日的数据库进行回顾性分析。使用国际疾病分类第十版（ICD - 10）诊断编码来识别CRC和CRCLM。分配给住院病例的手术编码用于识别手术治疗类型。化疗通过世界卫生组织药物解剖治疗化学分类系统来识别。评估治疗模式并计算五年总生存率（OS）。使用Kaplan - Meier方法估计生存率，并使用Cox比例风险回归进行组间生存比较。
3412例CRC患者中有601例（17.6%）在就诊时或随访期间被诊断为CRCLM。60例CRCLM患者（10.0%）接受了原发性CRC切除及肝转移灶切除，281例（46.8%）仅接受了CRC切除，180例（30%）仅接受了化疗，47例（7.8%）未接受任何治疗。这些组的五年OS分别为57.3%、15.6%、9.8%和0%。
南非私立部门人群中各种CRCLM治疗途径的五年OS与国际系列研究发表的结果相当。然而，与国际研究相比，接受肝切除的CRCLM患者比例较小。
