Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades
Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades
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DOI：
10.1007/s00384-015-2219-5
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发表时间：
2015-06-01
影响因子：
2.8
通讯作者：
Sigmar, Stelzner
中科院分区：
文献类型：
--
作者：
Joern, Fischer;Gunter, Hellmich;Sigmar, Stelzner
本研究旨在调查II期和III期直肠癌患者与II期和III期结肠癌患者相比的5年病因特异性生存率（CSS）、总生存率以及随时间推移的局部和联合复发率的结果。1981年至2011年期间在我们的结直肠病房接受治疗的355例连续结肠或直肠腺癌患者进行调查。该研究仅限于国际抗癌联盟（UICC）II期和III期。排除术后死亡率和组织学不完全切除，留下995例结肠癌患者和726例直肠癌患者进行进一步分析，结肠癌的五年CSS率从1981年至1986年治疗患者的65.0%提高到2007年至2011年治疗患者的88.1%。对于直肠癌患者，相应的5年CSS率从第一个观察期的53.4%提高到第二个观察期的89.8%。直肠癌的局部复发率从1981-1986年的34.2%下降到2007-2011年的2.1%。在过去十年的观察中，直肠癌的预后与结肠癌的预后相同（CSS 88.6 vs. 86.7%，p = 0.409）。在过去三十年中，结肠癌和直肠癌患者的生存率持续改善。在治疗策略发生重大变化后，包括引入全直肠系膜切除和新辅助（放射）化疗，II期和III期直肠癌的预后至少与II期和III期结肠癌一样好。
This study aimed to investigate the outcome for stage II and III rectal cancer patients compared to stage II and III colonic cancer patients with regard to 5-year cause-specific survival (CSS), overall survival, and local and combined recurrence rates over time.This prospective cohort study identified 3,355 consecutive patients with adenocarcinoma of the colon or rectum and treated in our colorectal unit between 1981 and 2011, for investigation. The study was restricted to International Union Against Cancer (UICC) stages II and III. Postoperative mortality and histological incomplete resection were excluded, which left 995 patients with colonic cancer and 726 patients with rectal cancer for further analysis.Five-year CSS rates improved for colonic cancer from 65.0 % for patients treated between 1981 and 1986 to 88.1 % for patients treated between 2007 and 2011. For rectal cancer patients, the respective 5-year CSS rates improved from 53.4 % in the first observation period to 89.8 % in the second one. The local recurrence rate for rectal cancer dropped from 34.2 % in the years 1981-1986 to 2.1 % in the years 2007-2011. In the last decade of observation, prognosis for rectal cancer was equal to that for colon cancer (CSS 88.6 vs. 86.7 %, p = 0.409).Survival of patients with colon and rectal cancer has continued to improve over the last three decades. After major changes in treatment strategy including introduction of total mesorectal excision and neoadjuvant (radio)chemotherapy, prognosis for stage II and III rectal cancer is at least as good as for stage II and III colonic cancer.