T1 结直肠癌淋巴管侵犯检测的差异及其对治疗的影响:荷兰全国性研究。

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-10-30 DOI:10.1002/ueg2.12670
Lisa van der Schee, Annabelle Verbeeck, Ivette A G Deckers, Chantal C H J Kuijpers, G Johan A Offerhaus, Tom C J Seerden, Frank P Vleggaar, Lodewijk A A Brosens, Leon M G Moons, Petur Snaebjornsson, Miangela M Laclé
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引用次数: 0

摘要

背景:淋巴管侵犯(LVI)在确定T1结直肠癌(CRC)患者淋巴结转移(LNM)风险、影响治疗决策和患者预后方面发挥着重要作用:本研究评估了荷兰不同实验室在检测 LVI 方面的差异,并调查了 LVI 对 T1 级 CRC 患者的治疗和肿瘤预后的影响:从荷兰全国病理数据库(Palga队列,n = 5513)中获取了2015年至2019年期间接受局部切除术的T1 CRC患者的病理报告和临床数据。有关 LVI 诊断标准(H&E/免疫组化)的数据不可用。我们将实验室分为低检测率、一般检测率和高检测率实验室,并评估了 LVI 检测方法对手术切除率和 LNM 阴性(LNM-)手术比例的影响。在研究的第二部分,我们使用荷兰 T1 CRC 工作组队列(n = 1268)来评估 LVI 检测方法对随访期间癌症复发的影响。我们使用多变量逻辑回归分析和 Cox 比例危险回归来研究 LVI 检测方法与结果之间的关系:在 PALGA 队列中,由 LVI 检测率高的实验室诊断的 T1 CRC 患者在局部切除后进行手术切除的比例明显更高(高与低:调整 OR [aOR] 1.87;95% 置信区间 [CI] 1.52-2.31),LNM 手术的比例也更高(aOR 1.73;95% CI 1.39-2.15)。在第二个队列中,与检测率低的实验室相比,检测率高的实验室诊断出的患者癌症复发率没有明显差异(aHR 2.23;95% CI 0.94-5.23):这些研究结果表明,LVI的高检出率并不能改善肿瘤预后,反而可能使更多患者接受不必要的肿瘤手术,因此需要对LVI的诊断进行标准化。
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Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study.

Background: Lymphovascular invasion (LVI) plays an important role in determining the risk of lymph node metastasis (LNM) in T1 colorectal cancer (CRC) patients and influencing treatment decisions and patient outcomes.

Objective: This study evaluated how the detection of LVI varies between Dutch laboratories and investigated its impact on the treatment and oncological outcomes of T1 CRC patients.

Methods: Pathology reports and clinical data of T1 CRC patients who underwent local resection between 2015 and 2019 were obtained from the Dutch nationwide pathology databank (Palga cohort, n = 5513). Data on the standard of LVI diagnosis (H&E/Immunohistochemistry) were not available. We categorized laboratories as low, average, or high detectors and evaluated the impact of LVI detection practice on the surgical resection rate and the proportion of LNM-negative (LNM-) surgeries. In the second part of the study, we used the Dutch T1 CRC Working Group cohort (n = 1268) to evaluate the impact of LVI detection practice on cancer recurrences during follow-up. Multivariable logistic regression analyses and Cox proportional hazard regression were used to study the association between LVI detection practice and the outcomes.

Results: In the PALGA cohort, the proportion of surgical resections after local resection of a T1 CRC was significantly higher among patients diagnosed by laboratories with a high LVI detection rate (high vs. low: adjusted OR [aOR] 1.87; 95% confidence interval [CI] 1.52-2.31) as was the proportion of LNM-surgeries (aOR 1.73; 95% CI 1.39-2.15). In the second cohort, no significant difference was observed in cancer recurrences among patients diagnosed in laboratories with high detection rates compared with low detection rates (aHR 2.23; 95% CI 0.94-5.23).

Conclusion: These findings suggest that a high detection rate of LVI does not improve oncological outcomes and may expose more patients to unnecessary oncological surgery, emphasizing the need for standardization of LVI diagnosis.

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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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