Department of Surgery, Northern Beaches Hospital, Sydney, New South Wales, Australia.
Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Jul;91(7-8):1569-1574. doi: 10.1111/ans.16734. Epub 2021 Apr 1.
Geographical remoteness and socioeconomic status (SES) are important factors affecting presentation stage and survival for colorectal cancer. A series of patients from a single institution in northern New South Wales was studied to determine if rural isolation or SES affected presentation and survival in patients undergoing resection.
Consecutive colorectal cancer resections performed at Lismore Base Hospital from 2011 to 2019 were identified. Patient residential addresses were categorized by the Modified Monash Model (MMM), an Australian Government definition of rural isolation, and Socioeconomic Index for Areas (SEIFA) quintiles, an Australian Bureau of Statistics index of socioeconomic deprivation. Univariate and Cox regression survival analysis was performed on data from histopathology and clinical notes matched with survival data.
A total of 405 patients were included in MMM categories 3 (n = 207, 51.1%), 4 (n = 69, 17%) and 5 (n = 129, 31.9) corresponding to large, medium and small rural towns. MMM 3 was associated with emergency cases (25.6% versus 18.7%, P < 0.001), nodal disease (44.4% versus 38.4%, P = 0.018) and T3/4 tumours (82.1% versus 73.7%, P < 0.001) compared with isolated patients without difference in 5-year survival (P = 0.370). Disadvantaged SEIFA quintiles 1/2 demonstrated increased poor differentiation (23.0% versus 15.4%, P < 0.001) and vascular invasion (15.8% versus 9.1%, P < 0.001) with reduced 5-year survival (57.0% versus 70.4%, P = 0.039). Independent predictors of survival included age, emergency cases, group stage, lymphatic invasion and low lymph node yield.
A 'rural reversal' may be present for patients in northern New South Wales; however, SES and established clinicopathological factors are the strongest predictors of survival in our population.
地理位置偏远和社会经济地位（SES）是影响结直肠癌患者就诊阶段和生存的重要因素。本研究对新南威尔士州北部单一医疗机构的一系列患者进行了研究，以确定农村隔离或 SES 是否影响接受切除术的患者的就诊和生存。
确定 2011 年至 2019 年利斯莫基地医院连续进行的结直肠切除术。根据澳大利亚政府定义的农村隔离的改良莫纳什模型（MMM）和澳大利亚统计局社会经济地位指数（SEIFA）五分位数对患者居住地址进行分类，该指数是社会经济贫困程度的指标。对组织病理学和临床记录中与生存数据匹配的数据进行单变量和 Cox 回归生存分析。
共纳入 405 名患者，MMM 类别 3（n=207，51.1%）、4（n=69，17%）和 5（n=129，31.9%）分别对应于大、中、小农村城镇。与孤立患者相比，MMM 3 与急诊病例（25.6%比 18.7%，P<0.001）、淋巴结疾病（44.4%比 38.4%，P=0.018）和 T3/4 肿瘤（82.1%比 73.7%，P<0.001）相关，5 年生存率无差异（P=0.370）。处于社会经济地位不利的 SEIFA 五分位数 1/2 组的分化程度较差（23.0%比 15.4%，P<0.001），血管侵犯（15.8%比 9.1%，P<0.001），5 年生存率降低（57.0%比 70.4%，P=0.039）。生存的独立预测因素包括年龄、急诊病例、组分期、淋巴浸润和低淋巴结产量。
对于新南威尔士州北部的患者，可能存在“农村逆转”；然而，SES 和既定的临床病理因素是我们人群中生存的最强预测因素。
