Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, University Hospital, Technische Universität Dresden, Dresden, Germany.
National Center for Tumor Diseases (NCT/UCC) & German Cancer Research Center (DKFZ) & University Hospital and Faculty of Medicine Carl Gustav Carus & Technische Universität Dresden & Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden and Heidelberg, Germany.
BMC Cancer. 2023 Mar 10;23(1):228. doi: 10.1186/s12885-023-10672-1.
Colorectal cancer (CRC) is one of the most common types of cancer in Western civilization and responsible for a high number of yearly deaths. Long-term outcome is influenced by many factors, potentially including socioeconomic aspects like income, education, and employment. Furthermore, annual surgical case volume plays a major role in achieving good oncological results. In our retrospective study, we evaluated the effect of socioeconomic deprivation and hospital volume on overall survival (OS) in the federal state of Saxony, Germany.
All patients with CRC who underwent surgery in Saxony, Germany between 2010 and 2020 and were living in Saxony at the time of diagnosis were included in our retrospective analysis. Uni- and multivariate analyses were conducted considering age, sex, tumor localization, UICC tumor stage, surgical approach (open/laparoscopic), number of resected lymph nodes, adjuvant chemotherapy, year of surgery, and hospital case volume. In addition, our model was adjusted for social disparity using the German Index of Socioeconomic Deprivation (GISD).
A total of 24,085 patients were analyzed (15,883 with colon cancer and 8,202 with rectal cancer). Age, sex, UICC tumor stage and tumor localization were distributed as expected for CRC. Median overall survival time was 87.9 months for colon cancer and 110.0 months for rectal cancer. Univariate analysis revealed laparoscopic surgery (colon and rectum P < 0.001), high case volume (rectum: P = 0.002) and low levels of socioeconomic deprivation (colon and rectum P < 0.001) to be significantly associated with better survival. In multivariate analyses, the associations of laparoscopic surgery (colon: HR = 0.76, P < 0.001; rectum: HR = 0.87, P < 0.01), and mid-low to mid-high socioeconomic deprivation (colon: HR = 1.18-1.22, P < 0.001; rectum: HR = 1.18-1.36, P < 0.001-0.01) remained statistically significant. Higher hospital case volume was associated with better survival only in rectal cancer (HR = 0.89; P < 0.01).
In Saxony, Germany, better long-term survival after CRC surgery was associated with low socioeconomic deprivation, laparoscopic surgery and partly with high hospital case volume. Thus, there is a need to reduce social differences in access to high-quality treatment and prevention and increase hospital patient volume.
结直肠癌（CRC）是西方文明中最常见的癌症类型之一，也是导致大量患者死亡的主要原因。长期预后受多种因素影响，包括收入、教育和就业等社会经济方面。此外，每年的手术例数对实现良好的肿瘤学结果起着重要作用。在我们的回顾性研究中，我们评估了德国萨克森州的社会经济贫困程度和医院容量对总体生存率（OS）的影响。
我们对 2010 年至 2020 年期间在德国萨克森州接受手术且在诊断时居住在萨克森州的所有 CRC 患者进行了回顾性分析。我们进行了单因素和多因素分析，考虑了年龄、性别、肿瘤定位、UICC 肿瘤分期、手术方式（开放/腹腔镜）、切除的淋巴结数量、辅助化疗、手术年份和医院手术例数。此外，我们的模型还通过德国社会经济剥夺指数（GISD）对社会差异进行了调整。
共分析了 24085 例患者（结肠癌 15883 例，直肠癌 8202 例）。年龄、性别、UICC 肿瘤分期和肿瘤定位与 CRC 相符。结肠癌的中位总生存时间为 87.9 个月，直肠癌为 110.0 个月。单因素分析显示，腹腔镜手术（结肠癌和直肠癌 P<0.001）、高手术例数（直肠癌：P=0.002）和低社会经济剥夺水平（结肠癌和直肠癌 P<0.001）与生存时间显著相关。多因素分析显示，腹腔镜手术（结肠癌：HR=0.76，P<0.001；直肠癌：HR=0.87，P<0.01）和中低至高社会经济剥夺（结肠癌：HR=1.18-1.22，P<0.001；直肠癌：HR=1.18-1.36，P<0.001-0.01）之间存在统计学意义。高医院手术例数仅与直肠癌的生存时间有关（HR=0.89；P<0.01）。
在德国萨克森州，CRC 手术后的长期生存与社会经济贫困程度较低、腹腔镜手术以及部分与高医院手术例数有关。因此，需要减少获得高质量治疗和预防服务的社会差异，并增加医院患者数量。
