Murshed Ishraq, Bedrikovetski Sergei, Bunjo Zachary, Kroon Hidde M, Thomas Michelle, Sammour Tarik
Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, Royal Adelaide Hospital, Adelaide, Australia.
Colorectal Unit, Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2025 Jul-Aug;95(7-8):1484-1492. doi: 10.1111/ans.70218. Epub 2025 Jun 10.
Total Neoadjuvant Therapy (TNT) has significantly improved outcomes in locally advanced rectal cancer. Despite rising use and inclusion in international guidelines, adoption patterns in Australia and New Zealand (ANZ) remain unclear. This study determines bi-national patterns and predictors of TNT utilisation over a 6-year period.
A retrospective population-based bi-national registry cohort study analysed data from the ANZ Bowel Cancer Outcome Registry from 2018 to 2024. Patients diagnosed with primary locally advanced rectal cancer (LARC) and treated with standard neoadjuvant therapy (SNT), consisting of long-course chemoradiotherapy or short-course radiotherapy, or TNT were included. The primary outcome was the incidence of TNT utilisation over time and determining pre-treatment predictive factors.
Of 33 270 patient entries, 3234 eligible LARC patients were identified, with 706 (21.8%) receiving TNT and 2528 (78.2%) receiving SNT. TNT usage increased from 11% in 2018 to 41% in 2023. On multivariable logistic regression, independent factors associated with decreased TNT use were older age (OR: 0.978, 95% CI: 0.970-0.985, p < 0.001), absence of multidisciplinary team discussion (OR: 0.113, 95% CI: 0.027-0.472, p = 0.003) and private health insurance (OR: 0.619, 95% CI: 0.441-0.869, p = 0.006). Factors associated with increased TNT use were clinical T4 tumours (OR: 2.020, 95% CI: 1.245-3.280, p = 0.004), node-positive status (OR: 1.481, 95% CI: 1.118-1.964, p = 0.006) and diagnosis during the years 2019-2023 (p < 0.05 for all).
TNT is increasingly used in surgical rectal cancer patients captured in the BCOR in ANZ. This study provides a baseline for future benchmarking patterns of rectal cancer management.
全新辅助治疗（TNT）显著改善了局部晚期直肠癌的治疗效果。尽管其使用日渐增多并被纳入国际指南，但澳大利亚和新西兰（ANZ）的采用模式仍不明确。本研究确定了6年间TNT使用的双边模式及预测因素。
一项基于人群的回顾性双边登记队列研究分析了2018年至2024年ANZ结直肠癌结局登记处的数据。纳入诊断为原发性局部晚期直肠癌（LARC）并接受标准新辅助治疗（SNT，包括长程放化疗或短程放疗）或TNT的患者。主要结局是TNT随时间的使用发生率及确定治疗前的预测因素。
在33270例患者记录中，识别出3234例符合条件的LARC患者，其中706例（21.8%）接受TNT，2528例（78.2%）接受SNT。TNT的使用从2018年的11%增至2023年的41%。多变量逻辑回归分析显示，与TNT使用减少相关的独立因素为年龄较大（比值比：0.978，95%置信区间：0.970 - 0.985，p < 0.001）、未进行多学科团队讨论（比值比：0.113，95%置信区间：0.027 - 0.472，p = 0.003）和拥有私人医疗保险（比值比：0.619，95%置信区间：0.441 - 0.869，p = 0.006）。与TNT使用增加相关的因素为临床T4肿瘤（比值比：2.020，95%置信区间：1.245 - 3.280，p = 0.004）、淋巴结阳性状态（比值比：1.481，95%置信区间：1.118 - 1.964，p = 0.006）以及2019 - 2023年期间确诊（所有年份p < 0.05）。
TNT在ANZ地区BCOR登记的直肠癌手术患者中使用日益增多。本研究为未来直肠癌管理的基准模式提供了基线。
