Trends with neoadjuvant radiotherapy and clinical staging for those with rectal malignancies
Trends with neoadjuvant radiotherapy and clinical staging for those with rectal malignancies
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DOI：
10.4240/wjgs.v9.i4.97
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发表时间：
2017-04-27
影响因子：
2
通讯作者：
Sigurdson, Elin R.
中科院分区：
文献类型：
--
作者：
Reddy, Sanjay S.;Handorf, Beth;Sigurdson, Elin R.
目的了解护理模式如何随着时间的推移而变化，以及机构类型如何影响这些决策。方法使用国家癌症数据库进行回顾性分析，观察1998年至2011年诊断为直肠癌的所有患者。我们测试了治疗率和阶段迁移率的差异。2检验和逻辑回归模型：对9594名接受直肠癌多模式治疗的受试者进行了回顾性研究。不同中心的分期和治疗反应差异很大。在学术实践中，46%的时间分期缺失，而在社区中心，54%的时间分期缺失（P < 0.001）。结果，在学术界，20%的人被降级，8%被升级，而在社区实践中，只有15%被降级，8%被升级（P < 0.001）。1998年，42%的人在手术前接受了放射治疗，两年内这一比例上升到53%。到2011年，这一比例增加到86%（P < 0.001）。各机构的具体待遇差别很大。1998年，51%的患者在手术前在学术中心接受治疗。在同一年的社区中，39%的人遵循这种模式（P < 0.001）。到2011年，91%的学术中心在手术前接受了放射治疗，而社区的比例为84%（P < 0.001）。采用率更好的学术界，虽然在这两个中心type.CONCLUSIONFrom研究日期的1998年至2011年，术前放射治疗一直在上升。学术界使用辐射的比率肯定有所增加，但在社区中也可以看到这种趋势。实践模式随着时间的推移而发展，尽管在开始术前治疗之前，临床分期的分配率严重低估。(C)作者（S）2017百世登出版集团有限公司出版All rights reserved.
AIMTo see how patterns of care changed over time, and how institution type effected these decisions.METHODSA retrospective analysis was performed using the National Cancer Database, looking at all patients that were diagnosed with rectal cancer from 1998 to 2011. We tested differences in rates of treatment and stage migration using. 2 tests and logistic regression models.RESULTSA review of ninety thousand five hundred and ninety four subjects underwent multimodality therapy for cancer of the rectum. Staging and response to treatment varied greatly between centers. Forty-six percent of the time staging was missing in academic practices, vs fiftyfour percent of the time in community centers (P < 0.001). As a result, twenty-percent were down-staged and eight percent up-staged in academia, whereas only fifteen percent were down-staged and 8% up-staged in community practices (P < 0.001). Forty-two percent of individuals underwent radiation before surgery in 1998.Within two years this increased to fifty-three percent. This increased to eighty-six percent by 2011 (P < 0.001). Institution specific treatment varied greatly. Fifty-one percent received therapy before surgery in academic centers in 1998. Thirty-nine percent followed this pattern in the same year in the community (P < 0.001). By 2011, ninety-one percent received radiation before their procedure in academic centers, vs eighty-four percent in the community (P < 0.001). Rates of adoption were better in academia, although an increase was seen in both center types.CONCLUSIONFrom the study dates of 1998 to 2011, preoperative treatment with radiation has been on the rise. There is certainly an increased rate of use of radiation in academia, however, this trend is also seen in the community. Practice patterns have evolved over time, although rates of assigning clinical stage are grossly underreported prior to initiation of preoperative therapy. (C) The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.