Long-term Outcomes After Resection for Submucosal Invasive Colorectal Cancers
Long-term Outcomes After Resection for Submucosal Invasive Colorectal Cancers
复制标题
DOI：
10.1053/j.gastro.2012.12.003
复制
发表时间：
2013-03-01
期刊：
影响因子：
29.4
通讯作者：
Saito, Yutaka
中科院分区：
文献类型：
--
作者：
Ikematsu, Hiroaki;Yoda, Yusuke;Saito, Yutaka
背景与目的：粘膜下浸润性结直肠癌患者接受内镜或手术切除的长期预后尚不清楚。我们对治疗粘膜下结肠癌和直肠癌患者的长期预后进行了回顾性分析。方法：我们收集了549例粘膜下结肠癌患者和209例粘膜下直肠癌患者的数据，这些患者在6家机构接受了内镜或手术切除，中位随访期为60.5个月。将患者分为仅行内镜切除的低危患者（A组）、仅行内镜切除的高危患者（B组）和行手术切除合并淋巴结清扫的高危患者（C组）。我们评估了复发率、5年无病生存率和5年总生存率。采用Cox回归分析比较复发率。结果：A组粘膜下结肠癌和直肠癌的复发率、无病生存率和总生存率分别为0%对6.3% （P < 0.05）、96%对90%、96%对89%。B组分别为1.4%对16.2% （P < 0.01）、96%对77% （P < 0.01）、98%对96%；局部复发5例（1例为粘膜下结肠癌，4例为粘膜下直肠癌）。肿瘤部位是唯一对疾病复发和死亡有显著影响的因素（危险比6.73;P < 0.045）。对于C组，这些值分别为1.9%对4.5%、97%对95%、99%对97%。结论：仅行内镜下切除术时，高危的粘膜下直肠癌患者局部复发的风险明显高于粘膜下结肠癌患者。因此，对于病理特征表明肿瘤进展风险高的粘膜下直肠癌患者，建议增加手术；大学医院医疗网络临床试验注册，编号：UMIN 000008635。
BACKGROUND & AIMS: Little is known about the long-term outcomes of patients with submucosal invasive colorectal cancer who undergo endoscopic or surgical resection. We performed a retrospective analysis of longterm outcomes of patients treated for submucosal colon and rectal cancer. METHODS: We collected data on 549 patients with submucosal colon cancer and 209 patients with submucosal rectal cancer who underwent endoscopic or surgical resection at 6 institutions over a median follow-up period of 60.5 months. Patients were classified into one of 3 groups: low-risk patients undergoing only endoscopic resection (group A), high-risk patients undergoing only endoscopic resection (group B), and high-risk patients undergoing surgical resection that included lymph node dissection (group C). We assessed recurrence rates, 5-year disease-free survival, and 5-year overall survival. Cox regression analysis was used to compare recurrences. RESULTS: The rates of recurrence, disease-free survival, and overall survival in group A for submucosal colon and rectal cancer were 0% versus 6.3% (P < .05), 96% versus 90%, and 96% versus 89%, respectively. For group B, these values were 1.4% versus 16.2% (P < .01), 96% versus 77% (P < .01), and 98% versus 96%, respectively; local recurrence was observed in 5 patients (one with submucosal colon cancer and 4 with submucosal rectal cancer). Tumor location was the only factor that contributed significantly to disease recurrence and death (hazard ratio, 6.73; P < .045). For group C, these values were 1.9% versus 4.5%, 97% versus 95%, and 99% versus 97%, respectively. CONCLUSIONS: The risk for local recurrence was significantly higher in high-risk patients with submucosal rectal cancer than in patients with submucosal colon cancer when treated with only endoscopic resection. The addition of surgery is therefore recommended for patients with submucosal rectal cancer with pathologic features indicating a high risk of tumor progression; University Hospital Medical Network Clinical Trials Registry, Number: UMIN 000008635.