仅靠结肠镜检查是否足以监测 I 期结直肠癌?

IF 4.1 2区 医学 Q2 ONCOLOGY Cancer Research and Treatment Pub Date : 2024-10-04 DOI:10.4143/crt.2024.526
Seijong Kim, Jung Kyong Shin, Yoonah Park, Jung Wook Huh, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Yong Beom Cho
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引用次数: 0

摘要

目的:根据 NCCN 指南,结肠镜检查是 I 期结直肠癌的标准监测工具,但其在检测复发方面的有效性还存在争议。本研究评估了 I 期结直肠癌的复发风险因素和模式,为综合监测策略提供依据:对在三星医疗中心接受根治术的 2,248 名 I 期结直肠癌患者(2007-2018 年)进行了回顾性分析。排除因素包括家族史、既往复发、术前治疗和数据不足。监测包括结肠镜检查、实验室检测和 CT 扫描:I期结直肠癌患者的5年无病生存率较高(98.3%为结肠癌,94.6%为直肠癌)。在 1,467 名结肠癌患者中,有 26 人(1.76%)复发。在 781 名直肠癌患者中,有 47 人(6.02%)复发。术前 CEA 水平升高和神经周围浸润是结肠癌复发的重要风险因素,而肿瘤萌芽则是直肠癌复发的重要风险因素。远处转移是结肠癌的主要复发模式(92.3%),而直肠癌则以局部复发为主(50%)。仅通过结肠镜检查发现复发的病例只占一小部分(结肠癌为 3.7%,直肠癌为 14.9%):结论:虽然 I 期结直肠癌的复发率很低,但仅靠结肠镜进行监测可能会漏诊结直肠以外的远处转移或局部复发。对于高危患者,我们建议在进行结肠镜检查的同时考虑定期进行 CT 扫描。这种有针对性的方法可以更早地发现复发,改善这部分患者的预后,同时避免对大多数低风险患者进行不必要的扫描。
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Is Colonoscopy Alone Adequate for Surveillance in Stage I Colorectal Cancer?

Purpose: While colonoscopy is the standard surveillance tool for stage I colorectal cancer according to NCCN guidelines, its effectiveness in detecting recurrence is debated. This study evaluates recurrence risk factors and patterns in stage I colorectal cancer to inform comprehensive surveillance strategies.

Materials and methods: A retrospective analysis of 2,248 stage I colorectal cancer patients who underwent radical surgery at Samsung Medical Center (2007-2018) was conducted. Exclusions were based on familial history, prior recurrences, preoperative treatments, and inadequate data. Surveillance included colonoscopy, laboratory tests, and CT scans.

Results: Stage I colorectal cancer patients showed favorable 5-year disease-free survival (98.3% colon, 94.6% rectal). Among a total of 1,467 colon cancer patients, 26 (1.76%) experienced recurrence. Of the 781 rectal cancer patients, 47 (6.02%) experienced recurrence. Elevated preoperative CEA levels and perineural invasion were significant recurrence risk factors in colon cancer, while tumor budding was significant in rectal cancer. Distant metastasis was the main recurrence pattern in colon cancer (92.3%), while rectal cancer showed predominantly local recurrence (50%). Colonoscopy alone detected recurrences in a small fraction of cases (3.7% in colon cancer and 14.9% in rectal cancer).

Conclusion: Although recurrence in stage I colorectal cancer is rare, relying solely on colonoscopy for surveillance may miss distant metastases or locoregional recurrence outside the colorectum. For high-risk patients, we recommend considering regular CT scans alongside colonoscopy. This targeted approach may enable earlier recurrence detection and improve outcomes in this subset while avoiding unnecessary scans for the low-risk majority.

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来源期刊
CiteScore
8.00
自引率
2.20%
发文量
126
审稿时长
>12 weeks
期刊介绍: Cancer Research and Treatment is a peer-reviewed open access publication of the Korean Cancer Association. It is published quarterly, one volume per year. Abbreviated title is Cancer Res Treat. It accepts manuscripts relevant to experimental and clinical cancer research. Subjects include carcinogenesis, tumor biology, molecular oncology, cancer genetics, tumor immunology, epidemiology, predictive markers and cancer prevention, pathology, cancer diagnosis, screening and therapies including chemotherapy, surgery, radiation therapy, immunotherapy, gene therapy, multimodality treatment and palliative care.
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