432 KB43 KB192920262015Jarm, KatjaPrimic-Žakelj, MajaRems, MiranZadnik, Vesnaštevilka:4letnik:84str. 277-286ISSN:1318-0347COBISSID:2030203URN:URN:NBN:SI:doc-Y6RA1K8GslSlovensko zdravniško društvoZdravniški vestnikbolnišnicehospitalskirurgijanapovedni dejavnikiprognostic factorsrak dankerectal cancersurgeryLokalna ponovitev bolezni pri bolnikih, operiranih zaradi nemetastatskega raka danke, zbolelih v obdobju 2003-2005| Local recurence of rectal cancer in patients with nonmetastatic disease, diagnosed in 2003-2005|Background: In the last decades, outcomes of rectal cancer treatment have been improving due to better understanding of tumor biology, neoadjuvant and adjuvant treatment and precise surgical technique, considering pathologic anatomical lines. The proportion of rectal cancer local recurrence (LR) has been substantially decreasing. Objectives of this study are primarily to find out whether there are statistically important differences between the two groups of rectal cancer patients, i.e. those with and without rectal local recurrence, in terms of certain risk factors, and secondly, to define prognostic factors of rectal local recurrence. Methods: A total of 787 nonmetastatic rectal cancer patients, diagnosed between 2003 and 2005, treated by surgery in all Slovenian hospitals, were enrolled retrospectively. The recurrence-free survival rates were calculated with Kaplan-Meier method. Log-rank test was used for statistical comparison of survival of two groups according to prognostic factors. The adjusted hazard ratios for significant prognostic factors of survival were calculated using Cox multivariate analysis. Results: Patients with LR had more tumors in the lower third of the rectum (p = 0.045), more abdominoperineal, Hartmann%s and local excisions (p = 0.000) and less radical operations (p = 0.005), more of them were operated on in hospitals with lesser caseload of patients (p = 0.000), more often were treated only surgically (p = 0.048), had more colon defects after tumor excision (p = 0.025) and had more distant disease recurrences (p = 0.000). In a follow-up period of 5.3 years, LR occurred in 13.1 % and in 54 % of those within 1.9 years after surgery. In the multivariate analysis, the statistically significant prognostic factors for recurrence-free survival were tumor%s rectal position, regional lymph node status and the hospital of surgery. Conclusions: The proportion of LR is an appropriate indicator of optimal multidisciplinary rectal cancer treatmentIzhodišča: Rezultati zdravljenja raka danke so se v zadnjih desetletjih izboljšali zaradi boljšega razumevanja biologije tumorja, dodatnega zdravljenja in natančnejšo kirurško uporabo anatomsko patoloških omejitev. Odločilno se je zmanjšalo število lokalnih ponovitev bolezni (LPB). Namen analize je preveriti, ali se skupini opazovanih bolnikov z rakom danke z LPB in brez nje med seboj glede na posamezne dejavnike tveganja statistično značilno razlikujeta in kateri so napovedni dejavniki za LPB raka danke. Metode: V analizo smo vključili 787 bolnikov z nemetastatskim rakom danke, diagnosticiranih v Sloveniji v letih 2003 do 2005, operiranih v okviru prvega zdravljenja. Preživetje brez LPB smo izračunali s Kaplan-Meierjevo metodo. Za statistično primerjavo preživetja dveh populacij glede na napovedne dejavnike smo uporabili log-rank test. Neodvisen vpliv napovednih dejavnikov na LPB smo vrednotili s Cox-ovim modelom sorazmernih tveganj. Rezultati: V primerjavi z bolniki brez LPB so imeli bolniki z LPB statistično značilno večkrat tumor v spodnji tretjini danke (p=0,045), več abdominoperinealnih, Hartmannovih in lokalnih resekcij tumorja (p=0,000), manj radikalnih operacij (p=0,005), več jih je bilo operiranih v srednje velikih in majhnih bolnišnicah (p =0,000), večkrat so bili zdravljeni samo z operacijo (p=0,048), pri operaciji je bilo večkrat poškodovano črevo (p=0,025) in imeli so več oddaljenih ponovitev bolezni (p=0,000). LPB se je pojavila pri 13,1 % bolnikov v povprečju 5,3 let po operaciji, 54 % vseh LPB je bilo v povprečju 1,9 let po operaciji. Multivariatna analiza je pokazala, da so neodvisni napovedni dejavniki za LPB lega tumorja v danki, stadij bezgavk in bolnišnica, kjer je bil bolnik operiranTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo