Behandlungsergebnisse des kolorektalen Karzinoms des Darmkrebszentrums Schwäbisch Gmünd - eine retrospektive Analyse der Jahre 2005-2012

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Dokumentart: Dissertation
Date: 2015-10
Language: German
Faculty: 4 Medizinische Fakultät
4 Medizinische Fakultät
Department: Medizin
Advisor: Hebart, Holger (Prof. Dr.)
Day of Oral Examination: 2015-10-01
DDC Classifikation: 610 - Medicine and health
Keywords: Dickdarmkrebs , Analyse
Other Keywords: Kolrektales Karzinom
License: Publishing license excluding print on demand
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Introduction: Colorectal cancer is the second leading cause of cancer-related death in Western nations. The implementation of a nationwide guideline-based therapy in certified cancer centers is necessary to achieve an improvement in patient outcomes. The intention of the study was to critically analyse treatment results in a community-based colorectal cancer center in Germany. Methods: The data of 356 patients with colon cancer (CC) and 191 patients with rectal cancer (RC) have been analysed from January 2005 till December 2012. Primary endpoint was disease free survival (DFS), disease specific survival (DSS) and overall survival (OS).The treatment results of this study have been compared with international published studies and the published results of the „Onkologischer Schwerpunkt Stuttgart e.V.“ (OSP), that analysed data of 5321 patients with CC and RC from 2004 till 2011. Results: The median age was 74 years for CC and 71 years for RC. Almost a quarter of the patients suffered from metastatic disease (CC 24,9%, RC 23%) at the time of diagnosis. The application of adjuvant chemotherapy (CT) in stage III CC was implemented in 60,2% of the cases. Neoadjuvant or adjuvant chemoradiation was applied in 72,9% of the cases with RC stage II or III. 5-year DSS was 59% for CC and 59,9% for RC. Stage (CC and RC, p<0,0001), gender (CC, p=0,0038), age (CC, p=0,0543), preoperative CEA value (CC and RC, p<0,0001), appearance of a disease recurrence (CC p=0,001, RC p=0,0001, adjuvant CT in stage III CC (p=0,0127) and resection of metastases (CC p<0,0001, RC p=0,0071) influenced the DSS. Compared to the OSP Stuttgart, patients of the Stauferklinikum are more frequently in a locally advanced or metastatic stage and older (CC+3 years, RC+4 years). Adjuvant CT in stage III CC (60,2% vs. 53,1%) and chemoradiation in stage II or III RC (72,9% vs. 59,6%) were applied to a comparable number of patients. 5-year OS was slightly lower (CC 51,3% vs. 56,1%; RC 50% vs. 58,7%), but 5-year DFS was comparable to the results of the OSP Stuttgart (CC 79,6% vs. 79,8%; RC 79,6% vs. 70,8%). Conclusions: The study demonstrates that the guideline-based therapy is used at a high rate in our community-based cancer center at the Stauferklinikum. 5-year DSS, DFS and OS were comparable to international published studies. The lower survival compared to the OSP Stuttgart is probably due to the higher proportion of high-risk and elderly patients in the Stauferklinikum. Especially for elderly patients, who still have a poor prognosis, it is imperative that new treatment approaches are developed.

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