Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group
Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group
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DOI：
10.1007/s00535-017-1318-1
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发表时间：
2017-11-01
影响因子：
6.3
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
--
作者：
Tamaru, Yuzuru;Oka, Shiro;Chayama, Kazuaki
我们的目的是阐明 T1 结直肠癌 (CRC) 患者内镜切除 (ER) 和手术切除后的长期结果。我们检查了 1992-2008 年间接受治疗且随访时间≥ 5 年的 T1 CRC 患者。根据日本结直肠癌协会 (JSCCR) 指南，ER 后未达到治愈标准的患者被定义为“非内镜可治愈”，并分为三组：单纯 ER（A 组：121 例患者）、ER 后追加手术（B 组：238 例患者）和单纯手术切除（C 组：342 例患者）。分析了长期结局和复发预测因素。在 882 名 T1 CRC 患者中，701 名无法通过内镜治愈。这些患者的复发率和 5 年总生存率 (OS) 分别为 0.6% 和 91.1%。在 A、B 和 C 组中，复发率分别为 5.0、5.5 和 3.8%，OS 率分别为 79.3、92.4 和 91.5% (p < 0.01)，5 年无病生存 (DFS) 率分别为 98.1、97.9 和 98.5%。 32 名患者出现局部复发或远处/淋巴结转移（A 组：6 例；B 组：13 例；C 组：13 例），14 例患者死于原发性 CRC（A 组：3 例；B 组：7 例；C 组：4 例）。年龄>= 65岁、突出的肉眼类型、阳性淋巴浸润和高出芽级别是非内镜可治愈患者复发的显着预测因素。我们的研究结果支持内镜可治愈T1 CRC的JSCCR标准。 T1 CRC 的 ER 不会使需要额外手术切除的患者的临床结果恶化。
We aimed to clarify the long-term outcomes of patients with T1 colorectal carcinoma (CRC) after endoscopic resection (ER) and surgical resection.We examined T1 CRC patients treated during 1992-2008 and who had >= 5 years of follow-up. Patients who did not meet the curative criteria after ER according to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines were defined as "non-endoscopically curable" and classified into three groups: ER alone (Group A: 121 patients), additional surgery after ER (Group B: 238 patients), and surgical resection alone (Group C: 342 patients). Long-term outcomes and predictors of recurrence were analyzed.Of the 882 patients with T1 CRC, 701 were non-endoscopically curable. Among these patients, recurrence and 5-year overall survival (OS) rates were 0.6 and 91.1%, respectively. In Groups A, B, and C, recurrence rates were 5.0, 5.5, and 3.8%, OS rates were 79.3, 92.4, and 91.5% (p < 0.01), and 5-year disease-free survival (DFS) rates were 98.1, 97.9, and 98.5%, respectively. Thirty-two patients experienced local recurrence or distant/lymph node metastasis (Group A: 6; Group B: 13; Group C: 13) and 14 patients died of primary CRC (Group A: 3; Group B: 7; Group C: 4). Age >= 65 years, protruded gross type, positive lymphatic invasion, and high budding grade were significant predictors of recurrence in non-endoscopically curable patients.Our findings supported the JSCCR criteria for endoscopically curable T1 CRC. ER for T1 CRC did not worsen the clinical outcomes of patients who required additional surgical resection.