T1期结直肠癌内镜切除术后复发的风险因素研究

Factors associated with postoperative recurrence of T1 colorectal cancer resected under endoscope

摘要:

摘要：目的??探讨T1期结直肠癌（CRC）行单独内镜切除术或内镜切除术后追加手术治疗后的复发情况。方法?该研究采用回顾性分析方法，纳入2005年1月-2012年12月在该院接受内镜下切除手术的389例T1期CRC患者。比较内镜切除术后追加手术组（ER+SURG组，n?=205）患者和单独内镜切除术组（单独ER组，n?=184）患者临床结果。结果?无追加手术指征（垂直切缘阴性、黏膜下深层浸润、淋巴管或静脉浸润、分化较差及高芽殖）患者复发风险极低。有追加手术指征患者，ER+SURG组累积复发风险（CRRs）为3.7%，单独ER组为20.1%（P?=0.001）。即使未接受追加手术，仅黏膜下深层浸润患者CRRs较低（ER+SURG组：2.3% vs单独ER组：3.4%，P?=0.537）。相反，除黏膜下深层浸润外还伴有其他手术指征患者（高风险患者），接受追加手术能够显著改善临床结局（CRRs：ER+SURG 组5.8%，单独ER组58.0%，P?=0.001）。结论?仅黏膜下深层浸润患者肿瘤复发风险较低，具有其他高风险特征患者肿瘤复发风险较高，接受追加手术获益较大。

Abstract:

Abstract: Obejective?To evaluate recurrence of colorectal cancer (CRC) after endoscopic resection or a combination of endoscopic resection and surgery for T1 colorectal tumors.?Methods?We conducted a retrospective study of 389 patients with T1 CRC treated by endoscopic resection from January 2005 to December 2012. We compared outcomes among patients who underwent subsequent surgery (ER?+?SURG, n?=?205) and those who did not (ER only, n?=?184) and statistically adjusted baseline differences between the two groups according to the propensity scores.?Results?There was almost no risk of cancer recurrence among patients without indications for surgery (these indications include tumors with vertical margins, deep submucosal invasion, lymphatic or venous invasion, poor differentiation, or high-grade budding). Among patients with indications for surgery, the cumulative risks of recurrence (CRRs) were 3.7% in the ER?+?SURG group and 20.1% in the ER only group (P?=?0.001). However, the patients with only deep submucosal invasion had a low CRRs, even without surgery (2.3% in the ER?+?SURG group and 3.4% in the ER only groups, P?=?0.537). In contrast, patients with indications for surgery other than deep submucosal invasion (high-risk patients) had much better outcomes when they also underwent surgery (CRRs: 5.8% in the ER?+?SURG group vs 58.0% in the ER only group, P?=?0.001).?Conclusions?T1 CRC patients with deep submucosal invasion only are at low risk for cancer recurrence. However, patients with other high-risk tumor features have greater risks for cancer recurrence and benefit from subsequent surgery.