Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Surgery. 2022 May;171(5):1185-1192. doi: 10.1016/j.surg.2021.08.032. Epub 2021 Sep 24.
National guidelines, including the National Accreditation Program for Rectal Cancer, recommend initiation of rectal cancer treatment within 60 days of diagnosis; however, the effect of timely treatment initiation on oncologic outcomes is unclear. The purpose of this study was to evaluate the impact on oncologic outcomes of initiation of rectal cancer treatment within 60 days of diagnosis.
This was a retrospective review of stage II/III rectal cancer patients performed using the United States Rectal Cancer Consortium, a collaboration of 6 academic medical centers. Patients with clinical stage II/III rectal cancer who underwent radical resection between January 1, 2010 and December 31, 2018 were included. The primary exposure was treatment initiation, defined as either resection or initiation of chemotherapy or chemoradiotherapy, within 60 days of diagnosis. The primary outcome was disease recurrence, and the secondary outcome was all-cause mortality.
A total of 1,031 patients meeting inclusion criteria were included in the analysis. Treatment was initiated within 60 days of diagnosis in 830 patients (80.5%) and after 60 days in 201 patients (20.3%). In multivariable logistic regression, older age, non-White race, and residence greater than 100 miles from the treatment center were significantly associated with delay in treatment beyond 60 days. In survival analysis, 167 patients (16.2%) experienced recurrent disease, and 127 patients (12.3%) died of any cause. In an adjusted model accounting for pathologic staging, treatment sequence, distance to care, age, comorbidities, treatment center, and receipt of adjuvant chemotherapy, neither progression-free survival nor all-cause mortality was significantly associated with timely initiation of therapy with hazard ratios of 1.09 (0.70, 1.69) and 1.03 (0.63, 1.66), respectively.
This study found no difference in oncologic outcomes with initiation of treatment beyond 60 days.
国家指南，包括直肠癌国家认证计划，建议在诊断后 60 天内开始直肠癌治疗；然而，及时开始治疗对肿瘤学结果的影响尚不清楚。本研究旨在评估诊断后 60 天内开始直肠癌治疗对肿瘤学结果的影响。
这是一项对美国直肠癌症联合会（由 6 个学术医疗中心合作组成的联盟）的 2 期/3 期直肠癌症患者进行的回顾性研究。纳入 2010 年 1 月 1 日至 2018 年 12 月 31 日期间接受根治性切除术的临床 2 期/3 期直肠癌症患者。主要暴露因素为治疗开始，定义为诊断后 60 天内进行的切除术或化疗或放化疗开始。主要结局是疾病复发，次要结局是全因死亡率。
共有 1031 名符合纳入标准的患者纳入分析。830 名患者（80.5%）在诊断后 60 天内开始治疗，201 名患者（20.3%）在 60 天后开始治疗。在多变量逻辑回归中，年龄较大、非白种人种族和居住地距离治疗中心超过 100 英里与治疗时间超过 60 天显著相关。在生存分析中，167 名患者（16.2%）出现疾病复发，127 名患者（12.3%）死于任何原因。在一个考虑病理分期、治疗顺序、距离、年龄、合并症、治疗中心和辅助化疗的接受情况的调整模型中，无进展生存率和全因死亡率均与及时开始治疗无显著相关性，风险比分别为 1.09（0.70，1.69）和 1.03（0.63，1.66）。
本研究发现，诊断后 60 天以上开始治疗与肿瘤学结果无差异。
