Mollen R M, Damhuis R A, Coebergh J W
Department of Surgery, St Joseph Hospital Veldhoven, The Netherlands.
Eur J Surg Oncol. 1997 Feb;23(1):20-3. doi: 10.1016/s0748-7983(97)80137-0.
We carried out a population-based audit of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1981 and 1986. The study comprises 372 patients treated for rectal cancer in five community hospitals in the south-east of the Netherlands. The follow-up period was 7-12 years. We studied the medical records of these patients in the Eindhoven Cancer Registry, and by checking the endoscopical, surgical and pathological reports, we traced the following events: local recurrence, distant metastasis and (cause of) death. Curative resection was carried out in 232 of the 372 cases (62%); post-operative radiotherapy was administered to 27% of stage B2 and 50% of stage C (Astler-Coller) patients. Crude and net 5-year survival rates were 45% and 58%, respectively. Local recurrence rates were 18%, without much variation per hospital. After adjustment for age, gender, tumour site and type of surgery, local recurrence was primarily determined by tumour penetration of the muscularis propria and lymph node infiltration, the relative risks being 2.5 and 3.1, respectively (90% confidence intervals: 1.1-5.9 and 1.5-6.4). Although patients with cancer of the distal segment (0-6 cm) had shorter survival times than with proximal tumours, tumour site only weakly influenced local recurrence rates. These results confirm that the risk of recurrence for stage B2 and C patients can be reduced by more extensive surgical procedures. This study has contributed to the growing awareness of improved surgical treatment in rectal cancer.
我们对1981年至1986年间确诊的接受根治性切除的直肠癌患者的局部复发率进行了基于人群的审计。该研究包括荷兰东南部五家社区医院治疗的372例直肠癌患者。随访期为7至12年。我们研究了埃因霍温癌症登记处这些患者的病历，并通过检查内镜、手术和病理报告，追踪了以下事件：局部复发、远处转移和死亡（原因）。372例患者中有232例（62%）进行了根治性切除；27%的B2期和50%的C期（阿斯特勒-科勒分期）患者接受了术后放疗。5年粗生存率和净生存率分别为45%和58%。局部复发率为18%，各医院之间差异不大。在对年龄、性别、肿瘤部位和手术类型进行调整后，局部复发主要由肿瘤侵犯固有肌层和淋巴结浸润决定，相对风险分别为2.5和3.1（90%置信区间：1.1 - 5.9和1.5 - 6.4）。尽管远端段（0 - 6厘米）癌症患者的生存时间比近端肿瘤患者短，但肿瘤部位对局部复发率的影响较小。这些结果证实，对于B2期和C期患者，更广泛的手术操作可以降低复发风险。这项研究有助于提高人们对直肠癌手术治疗改善的认识。
