Background

Rectal cancer treatment is often multimodal, comprising of surgery, chemotherapy, and radiotherapy. However, the impact of coordination between these modalities is currently unknown. We aimed to assess whether delivery of nonsurgical therapy within same facility as surgery impacts survival in patients with rectal cancer.

Methods

A patient cohort with rectal cancer stages II to IV who received multimodal treatment between 2004 and 2016 from National Cancer Database was retrospectively analyzed. Patients were categorized into three groups: (A) surgery + chemotherapy + radiotherapy at same facility (surgery + 2); (B) surgery + chemotherapy or radiotherapy at same facility (surgery + 1); or (C) only surgery at reporting facility (chemotherapy + radiotherapy elsewhere; surgery + 0). The primary outcome was 5-year overall survival (OS), analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models.

Results

A total of 44,716 patients (16,985 [37.98%] surgery + 2, 12,317 [27.54%] surgery + 1, and 15,414 [34.47%] surgery + 0) were included. In univariate analysis, we observed that surgery+2 patients had significantly greater 5-year OS compared to surgery + 1 or surgery + 0 patients (5-year OS: 63.46% vs 62.50% vs 61.41%, respectively; P= .002). We observed similar results in multivariable Cox proportional-hazards analysis, with surgery + 0 group demonstrating increased hazard of mortality when compared to surgery + 2 group (HR: 1.09; P< .001). These results held true after stratification by stage for stage II (HR 1.10; P= .022) and stage III (HR 1.12; P< .001) but not for stage IV (P= .474).

Conclusion

Greater degree of care coordination within the same facility is associated with greater OS in patients with stage II to III rectal cancer. This finding illustrates the importance of interdisciplinary collaboration in multimodal rectal cancer therapy.

中文翻译：

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治疗协调对直肠癌总生存期的影响

背景

直肠癌治疗通常是多模式的，包括手术、化学疗法和放射疗法。然而，目前尚不清楚这些方式之间协调的影响。我们旨在评估在与手术相同的设施内提供非手术治疗是否会影响直肠癌患者的生存。

方法

回顾性分析了国家癌症数据库中在 2004 年至 2016 年间接受多模式治疗的直肠癌 II 至 IV 期患者队列。患者分为三组：（A）手术+化疗+放疗在同一设施（手术+2）；(B) 在同一设施进行手术+化疗或放疗（手术+1）；或 (C) 仅在报告机构进行手术（化学疗法 + 其他地方的放射疗法；手术 + 0）。主要结果是 5 年总生存期 (OS)，使用 Kaplan-Meier 曲线、对数秩检验和 Cox 比例风险模型进行分析。

结果

共纳入 44,716 名患者（16,985 [37.98%] 手术 + 2、12,317 [27.54%] 手术 + 1 和 15,414 [34.47%] 手术 + 0）。在单变量分析中，我们观察到手术+2 患者的 5 年 OS 显着高于手术 + 1 或手术 + 0 患者（5 年 OS：分别为 63.46% vs 62.50% vs 61.41%；P = .002） . 我们在多变量 Cox 比例风险分析中观察到类似的结果，与手术 + 2 组相比，手术 + 0 组的死亡率增加（HR：1.09；P < .001）。这些结果在 II 期（HR 1.10；P = .022）和 III 期（HR 1.12；P < .001）按阶段分层后仍然成立，但对于 IV 期（P = .474）则不然。

结论

同一设施内更大程度的护理协调与 II 至 III 期直肠癌患者的更高 OS 相关。这一发现说明了跨学科合作在多模式直肠癌治疗中的重要性。