Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival
Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival
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DOI：
10.7196/samj.2018.v108i2.12338
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发表时间：
2018-02-01
期刊：
影响因子：
--
通讯作者：
Ramos, J
中科院分区：
文献类型：
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作者：
Brand, M;Gaylard, P;Ramos, J
背景结直肠癌（CRC）是南非（SA）第四大常见癌症，也是第六大致命癌症。大约25%的患者在其原发性CRC诊断时患有同步转移性疾病。虽然在疾病的大多数阶段使用化疗，但原发肿瘤和转移瘤的手术切除仍然是实现治愈或延长生存期的最成功的治疗方式。到目前为止，SA. Objectives上还没有关于CRC表现和管理的数据。为了确定CRC的介绍，一般管理模式和总生存率在SA私人医疗保健部门。对2008年1月1日至2015年12月31日期间私人医疗保健资助者数据库的回顾性审查。疾病和相关健康问题国际统计分类（第10版）（ICD-10）诊断代码用于识别结直肠癌和肝和/或肺转移性疾病。分配给入院的程序代码用于识别手术治疗的类型。化疗是由世界卫生组织的药物解剖治疗化学分类系统确定的。确定治疗模式并计算5年生存率。使用Kaplan-Meier方法估计生存率，使用考克斯比例风险回归进行组间生存率比较。使用SAS 9.4版Windows进行数据分析。共纳入3412例患者，其中2267例仅为CRC，1145例为肝（LM）或肺转移（PM）。平均年龄为64.1岁（范围21-97岁），54.6%为男性;研究组之间无统计学差异。20%的LM或PM患者接受了转移瘤的手术切除。单纯结直肠癌、CRCLM、CRCPM和CRCLMPM手术切除后5年生存率分别为71.7%、57.3%、31.5%和26.0%。在私营医疗保健部门接受治疗的SA CRC患者的疾病表现与已发表的国际系列相似，不同治疗途径的结局相似;然而，与国际趋势相比，似乎进行了较少的转移瘤切除术。
Background. Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA.Objectives. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector.Methods. A retrospective review of a private healthcare funder's database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows.Results. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21-97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively.Conclusions. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.