T1期结直肠癌内镜切除后再行补充手术与直接手术治疗的远期疗效比较
Long-term outcomes of additional surgery after endoscopic resection versus primary surgery for T1 colorectal cancer
TAMARU Y KUWAI T KAJIWARA Y 张博翔 1李建男1
作者信息
- 1. 吉林大学第二医院结直肠及肛门外科 吉林长春 130021
- 折叠
摘要
背景 对于T1期结直肠癌,内镜切除后再行补充手术是否会造成肿瘤学上的不良影响备受关注.本研究旨在通过倾向性评分匹配分析,比较接受内镜切除后进行补充手术与直接手术治疗T1期结直肠癌患者的长期结局.方法 本研究纳入了2009年至2016年间在日本27家大型医院接受内镜切除或外科切除的6105例T1期结直肠癌患者,其中单独接受手术的患者被纳入直接手术组,而在内镜切除后接受补充手术的患者被纳入补充手术组.采用倾向性评分匹配分析长期结果,包括死亡率和复发率.结果 经过倾向性评分匹配后,两个组分别确定了 1219例患者(共2438例).补充手术组和直接手术组的5年总体生存率分别为97.1％和96.0％(风险比为0.72,95％CI为0.49～1.08),表明补充手术组的非劣效性.此外,补充手术组中有32例患者(2.6％)出现复发,而直接手术组中有24例(2.0％),两组之间比较差异没有统计学意义(比值比为1.34,95％CI为0.76～2.40,P=0.344).讨论 对于T1期结直肠癌患者,在补充手术之前进行内镜切除对患者的长期结局(包括5年总体生存率)没有不良影响.对于可切除的T,期结直肠癌,内镜切除是一种可行的一线治疗选择.
Abstract
Introduction There is considerable concern about whether endoscopic resection(ER)prior to additional sur-gery(AS)for T1 colorectal cancer(CRC)has oncologically potential adverse effects.Therefore,this study aimed to com-pare the long-term outcomes,including overall survival(OS),of patients treated with AS after ER versus primary sur-gery(PS)for T1 CRC using a propensity score-matched analysis from a large observational study.Methods This study investigated 6,105 patients with T1 CRC treated with either ER or surgical resection between 2009 and 2016 at 27 high-volume Japanese institutions,with those undergoing surgery alone included in the PS group and those undergoing AS after ER included in the AS group.Propensity score matching was used for long-term outcomes of mortality and re-currence analysis.Results After propensity score matching,1,219 of 2,438 patients were identified in each group.The 5-year OS rates in the AS and PS groups were 97.1％and 96.0％,respectively[hazard ratio(HR):0.72;95％confidence interval(CI):0.49-1.08],indicating the non-inferiority of the AS group.Moreover,32 patients(2.6％)in the AS group and 24(2.0％)in the PS group had recurrences,with no significant difference between the two groups[odds ratio(OR):1.34;95％CI:0.76-2.40;P=0.344).Discussion ER prior to AS for T1 CRC had no adverse effect on patients'long-term outcomes,including the 5-year OS rate.ER is a viable first-line treatment option for endoscopically resectable T1 CRC.
关键词
T1期/结直肠癌/总体生存/复发/内镜切除Key words
T1/colorectal cancer/overall survival/recurrence/endoscopic resection引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据