局部晚期直肠癌患者的传统治疗模式是新辅助放化疗，然后进行根治性手术和辅助化疗。本研究旨在评估局部晚期直肠癌的手术趋势、与放弃手术相关的因素以及总体生存结果。使用国家癌症数据库（2004-2019）对患有局部晚期直肠癌的成人进行回顾性分析。进行了倾向评分匹配。使用多变量逻辑回归确定与不接受手术相关的因素。使用 Kaplan-Meier 和对数秩检验进行 5 年总体生存分析，按分期和治疗类型分层。总共确定了 72,653 例患者，其中 64,396 例（88.64%）患者接受新辅助手术±辅助治疗，579 例（0.80） %) 仅化疗，916 (1.26%) 仅放疗，6,762 (9.31%) 仅放化疗。研究期间接受手术的患者比例有所下降（2006 年的 95.61% 降至 2019 年的 92.29%，P 趋势 < .001），而拒绝手术的患者比例则有所增加（1.45%-4.48%，P 趋势 < .001）。 001）。不接受局部晚期直肠癌手术的相关因素包括年龄较大、黑人种族（比值比 1.47，95% CI 1.35-1.60，P < .001）、较高的 Charlson-Deyo 评分（评分≥3：1.79、1.58-2.04） ，P < .001）、II 期癌症（1.22、1.17-1.28，P < .001）、较低的家庭收入中位数和非私人保险。在未匹配和匹配队列中，无论分期如何，新辅助手术±辅助治疗均与最佳 5 年总生存率相关。尽管手术仍然是局部晚期直肠癌治疗中不可或缺的组成部分，但与指南一致的生存率却出现了令人担忧的下降美国直肠癌的手术治疗，有证据表明存在持续的社会经济差异。提供者应设法了解患者的观点/障碍，并在合适的情况下指导他们进行手术。通过国家认证计划持续标准化、实施和评估直肠癌护理对于确保所有患者获得最佳治疗是必要的。版权所有 © 2023 Elsevier Inc. 保留所有权利。

The traditional treatment paradigm for patients with locally advanced rectal cancers has been neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. This study aimed to assess surgery trends for locally advanced rectal cancers, factors associated with forgoing surgery, and overall survival outcomes.Adults with locally advanced rectal cancers were retrospectively analyzed using the National Cancer Database (2004-2019). Propensity score matching was performed. Factors associated with not undergoing surgery were identified using multivariable logistic regression. Kaplan-Meier and log-rank tests were used for 5-year overall survival analysis, stratified by stage and treatment type.A total of 72,653 patients were identified, with 64,396 (88.64%) patients undergoing neoadjuvant + surgery ± adjuvant therapy, 579 (0.80%) chemotherapy only, 916 (1.26%) radiation only, and 6,762 (9.31%) chemoradiation only. The proportion of patients who underwent surgery declined over the study period (95.61% in 2006 to 92.29% in 2019, P trend < .001), whereas the proportion of patients who refused surgery increased (1.45%-4.48%, P trend < .001). Factors associated with not undergoing surgery for locally advanced rectal cancers included older age, Black race (odds ratio 1.47, 95% CI 1.35-1.60, P < .001), higher Charlson-Deyo score (score ≥3: 1.79, 1.58-2.04, P < .001), stage II cancer (1.22, 1.17-1.28, P < .001), lower median household income, and non-private insurance. Neoadjuvant + surgery ± adjuvant therapy was associated with the best 5-year overall survival, regardless of stage, in unmatched and matched cohorts.Despite surgery remaining an integral component in the management of locally advanced rectal cancers, there is a concerning decline in guideline-concordant surgical care for rectal cancer in the United States, with evidence of persistent socioeconomic disparities. Providers should seek to understand patient perspectives/barriers and guide them toward surgery if appropriate candidates. Continued standardization, implementation, and evaluation of rectal cancer care through national accreditation programs are necessary to ensure that all patients receive optimal treatment.Copyright © 2023 Elsevier Inc. All rights reserved.