Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur J Surg Oncol. 2022 Aug;48(8):1831-1839. doi: 10.1016/j.ejso.2022.04.013. Epub 2022 Apr 30.
Treatment options for advanced and metastatic rectal cancer have increased during the past decades. However, a considerable proportion of the patients are not eligible for curative treatment, and data on this subset are scarce from a population-based perspective. This study aimed to describe treatment pathways and survival in a national cohort of patients with primary stage IV rectal cancer or stage I-III rectal cancer not eligible for curative treatment.
A national cohort of all patients reported 2008-2015 to the Norwegian Colorectal Cancer Registry with primary metastatic rectal cancer or who did not undergo curative resections for stage I-III rectal cancer was studied with regard to patient characteristics, treatments, and survival.
Of 8291 patients diagnosed with rectal cancer, 3304 (39.9%) were eligible for analysis. The majority (76.8%) had metastatic disease, and 23.2% did not undergo curative resections for other reasons. We identified four main treatment journeys: no tumour-directed treatment, 25.1%; resection of the primary tumour, 44.6%; oncological treatment, 28.4%; and R0 resection of the primary tumour and metastases, 1.9%; these translated into ten different treatment pathways. Survival differed considerably between a median of 5.3 months for M1 disease with non-tumour-directed treatment to a five-year survival of 67% for M1 with R0 resection.
Almost 40% of all patients with rectal cancer did not enter a curative-intent treatment pathway. The patient journeys and outcomes varied greatly. This large but understudied population warrants further in-depth analyses of treatment efficacy and effects on quality of life.
在过去几十年中，治疗晚期和转移性直肠癌的选择有所增加。然而，相当一部分患者不符合治愈性治疗的条件，从基于人群的角度来看，这方面的数据很少。本研究旨在描述原发性 IV 期直肠癌或不符合根治性治疗条件的 I-III 期直肠癌患者的全国性队列中的治疗途径和生存情况。
对 2008-2015 年向挪威结直肠癌登记处报告的原发性转移性直肠癌或未接受 I-III 期直肠癌根治性切除术的所有患者的全国性队列进行了研究，以评估患者特征、治疗方法和生存情况。
在 8291 例诊断为直肠癌的患者中，有 3304 例（39.9%）符合分析条件。大多数（76.8%）患者患有转移性疾病，23.2%的患者因其他原因未进行根治性切除术。我们确定了四种主要的治疗途径：无肿瘤靶向治疗，占 25.1%；原发肿瘤切除术，占 44.6%；肿瘤治疗，占 28.4%；以及原发肿瘤和转移灶的 R0 切除术，占 1.9%；这转化为十种不同的治疗途径。中位无肿瘤靶向治疗 M1 疾病的生存时间为 5.3 个月，而 R0 切除 M1 的 5 年生存率为 67%，生存差异显著。
几乎 40%的直肠癌患者没有进入治愈性治疗途径。患者的治疗途径和结果差异很大。这一庞大但研究不足的人群需要进一步深入分析治疗效果和对生活质量的影响。
