Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study
Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study
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DOI：
10.1007/s00535-015-1144-2
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发表时间：
2016-07-01
影响因子：
6.3
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Asayama, Naoki;Oka, Shiro;Chayama, Kazuaki
带蒂型T1型结直肠癌的淋巴结转移风险和预后意义需要进一步研究。我们的目的是评估2014年日本结直肠癌协会(JSCCR)指南的有效性，该指南基于带蒂T1型大肠癌的长期结果。在这项多中心回顾队列研究中，我们检查了在1990年1月至2010年12月期间在14个机构接受内窥镜或手术切除的176名患者。符合JSCCR疗效标准的患者被定义为“内窥镜可治愈(可电子治愈)”，而那些不能被定义为“不可电子可治愈”。对116例(58例可治愈，58例不可治愈)患者治疗5年后的预后进行了评估。总的淋巴结转移率为5%(4/81；95%可信区间为1.4~12%：3例粘膜下侵犯深度为千分之1[茎侵犯]和淋巴侵犯，1例为头部侵犯和萌芽生长2/3)。可治愈的患者无局部或转移复发，但其中6例死于其他原因(观察期80个月)。不能治愈的患者没有局部复发，但有一名患者观察到远处转移。在不能治愈的患者中没有观察到原发病死亡，但其中6人死于其他原因(观察期72个月)。我们的数据支持JSCCR对T1型带蒂癌的疗效标准的有效性。内窥镜切除不能被认为是仅对有头部侵犯的带蒂型T1结肠癌的治愈。
The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs.In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as "endoscopically curable (e-curable)" and those who did not were "non-e-curable". We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for > 5 years after treatment.Overall incidence of lymph node metastasis was 5 % (4/81; 95 % confidence interval 1.4-12 %: three cases of submucosal invasion depth a parts per thousand yen1000 mu m [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80 months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72 months).Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.