Long-term prognostic outcomes in high-risk T1 colorectal cancer: A multicentre retrospective comparison of surgery versus observation postendoscopic treatment

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-06 DOI:10.1111/codi.17269

Yosuke Atsumi, Masakatsu Numata, Jun Watanabe, Atsuhiko Sugiyama, Atsushi Ishibe, Yuichiro Ozeki, Kingo Hirasawa, Keiichi Ashikari, Takuma Higurashi, Akio Higuchi, Shinpei Kondo, Naoya Okada, Hideyuki Chiba, Hirokazu Suwa, Hiroaki Kaneko, Kanji Okuma, Teni Godai, Itaru Endo, Shin Maeda, Atsushi Nakajima, Yasushi Rino, Aya Saito

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Abstract

Aim

The risk of lymph node metastasis after endoscopic resection of high-risk T1 colorectal cancer prompts additional resection. However, age and comorbidities are considered in decision-making and some surgeons opt for observation. We compared the long-term outcomes of these approaches with the aim of clarifying the need for additional resection.

Method

This multicentre retrospective study included high-risk T1 colorectal cancer patients treated with endoscopic submucosal dissection (ESD) between January 2013 and April 2021. Patients who met one or more of the following criteria were eligible for inclusion: submucosal invasion depth ≥1000 μm, vessel invasion, poor differentiation, budding grade 2/3 or a positive vertical margin. Patients were divided into resection (R) and observation (O) groups. Outcomes were evaluated based on overall survival (OS) and 5-year cancer-specific survival (CSS), with an additional stratified analysis using the age-adjusted Charlson comorbidity index (ACCI).

Results

The study included 178 patients (group R, n = 131; group O, n = 47). Patients in group O were significantly older and had more comorbidities. Group R showed better 5-year OS and CSS (OS 87.0% vs. 58.9%, p = 0.001; CSS 98.8% vs. 78.4%, p = 0.002). Stratification by ACCI revealed that benefits of additional resection remained for patients with ACCI ≤ 6 (OS 91.2% vs. 58.3%, p = 0.013; CSS 98.4% vs. 61.7%, p < 0.001) but not for those with ACCI ≥7 (OS 75.9% vs. 59.8%, p = 0.289; CSS 100% vs. 100%, p = 0.617).

Conclusions

Significant survival benefits were demonstrated in group R patients with high-risk T1 cancer. However, the survival benefit of additional surgical resection was unconfirmed in patients with ACCI ≥ 7.

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高风险T1型结直肠癌的长期预后：内镜治疗后手术与观察的多中心回顾性比较

目的探讨内镜下高危T1型结直肠癌切除术后淋巴结转移的风险。然而，年龄和合并症是决策的考虑因素，一些外科医生选择观察。我们比较了这些入路的长期结果，目的是明确是否需要额外切除。方法本研究为多中心回顾性研究，纳入2013年1月至2021年4月接受内镜下粘膜下剥离（ESD）治疗的T1期高危结直肠癌患者。符合以下一个或多个标准的患者有资格纳入：粘膜下浸润深度≥1000 μm，血管浸润，分化差，出芽2/3级或垂直边缘阳性。患者分为切除组(R)和观察组(O)。结果基于总生存期（OS）和5年癌症特异性生存期（CSS）进行评估，并使用年龄调整Charlson合并症指数（ACCI）进行额外的分层分析。结果共纳入178例患者(R组，n = 131；O组，n = 47)。O组患者明显年龄大，合并症多。R组5年OS和CSS较好(OS 87.0% vs. 58.9%, p = 0.001；CSS 98.8% vs. 78.4%, p = 0.002)。ACCI分层显示，对于ACCI≤6的患者，额外切除的益处仍然存在(OS 91.2% vs. 58.3%, p = 0.013；CSS 98.4% vs. 61.7%, p < 0.001)，但ACCI≥7的患者无统计学意义(OS 75.9% vs. 59.8%, p = 0.289；CSS 100% vs. 100%, p = 0.617)。结论R组高危T1癌患者的生存获益显著。然而，在ACCI≥7的患者中，额外手术切除的生存获益尚未得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.