追加外科手术治疗对高风险T1期结直肠癌内镜切除患者的预后影响OA北大核心CSTPCDMEDLINE
Prognosis Analysis of Additional Surgical Treatment for High-Risk T1 Colorectal Cancer Patients After Endoscopic Resection
目的 分析内镜下切除后追加外科手术对于高风险T1期结直肠癌患者生存预后的影响.方法 回顾性收集高风险T1期结直肠癌患者,根据内镜下切除后是否追加外科手术分为追加外科手术(endoscopic resection+surgical resection,ER+SR)组和内镜切除(endoscopic resection,ER)组,收集患者基线信息及病变部位、大小、术后病理等资料,并通过病历系统及随访等获得患者生存相关信息,主要结局指标为总生存率以及结直肠癌特异性生存率.采用单因素Cox回归分析分析筛选生存相关风险因素,计算风险比(HR),并通过多因素Cox回归分析独立影响因素.结果 共收集109例高风险T1期结直肠癌患者,其中ER组52例,ER+SR组57例,ER组的患者平均年龄高于ER+SR组(65.21岁 vs.60.54岁,P=0.035),ER组内镜下病变长径中位数略小于ER+SR组(2.00 cm vs.2.50 cm,P=0.026).ER+SR组中位随访时间为30.00个月,最长随访119.00个月,共有4名患者死亡,1名为结直肠癌相关死亡;而ER组中位随访时间为28.50个月,最长随访78.00个月,共有4名患者死亡,1名死于结直肠癌.5年累积生存率比较中,ER+SR组及ER组总生存率分别为94.44%和81.65%,而5年累积肿瘤特异性生存率分别为97.18%和98.06%.Kaplan-Meier分析显示ER+SR组及ER组患者累积总生存率、累积肿瘤特异性生存率差异无统计学意义.Cox单因素回归分析显示年龄及复查次数为总生存率相关危险因素(HR=1.16及0.27,P=0.005及0.025),进一步多因素Cox回归分析显示年龄为总生存率相关独立危险因素(HR=1.10,P=0.045).结论 对于内镜切除术后存在高风险因素的T1期结直肠癌患者,也不可忽视患者年龄、自身意愿等因素,在实际临床实践过程中更加慎重地选择追加外科手术.
Objective To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.Methods The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected.The patients were divided into the endoscopic resection(ER)plus additional surgical resection(SR)group,or the ER+SR group,and the ER group according to whether additional SR were performed after ER.Baseline data of the patients and information on the location,size,and postoperative pathology of the lesions were collected.Patient survival-related information was obtained through the medical record system and patient follow-up.The primary outcome indicators were the overall survival and the colorectal cancer-specific survival.Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio(HR)was calculated.Multivariate Cox regression analysis was used to analyze the independent influencing factors.Results The data of 109 patients with T1 high-risk colorectal cancer were collected,with 52 patients in the ER group and 57 patients in the ER+SR group.The mean age of patients in the ER group was higher than that in the ER+SR group(65.21 years old vs.60.54 years old,P=0.035),and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group(2.00 cm vs.2.50 cm,P=0.026).The median follow-up time was 30.00 months,with the maximum follow-up time being 119 months,in the ER+SR group and there were 4 patients deaths,including one colorectal cancer-related death.Whereas the median follow-up time in the ER group was 28.50 months,with the maximum follow-up time being 78.00 months,and there were 4 patient deaths,including one caused by colorectal cancer.The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44%and 81.65%,respectively,and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18%and 98.06%,respectively.The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups.Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival(HR=1.16 and HR=0.27,respectively),with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis(HR=1.10,P=0.045).Conclusion For T1 colorectal cancer patients with high risk factors after ER,factors such as patient age and their personal treatment decisions should not be overlooked.In clinical practice,additional caution should be exercised in decision-making concerning additional surgery.
罗鑫悦;陈宇翔;杨锦林;邓凯;吴俊超;甘涛
四川大学华西医院 消化内科 (成都 610041)
T1期结直肠癌高风险内镜切除外科手术生存预后
T1 colorectal cancerHigh risk factorsEndoscopic resectionSurgical resectionSurvival analysis
《四川大学学报(医学版)》 2024 (002)
ENAH调控Hippo-YAP信号通路促进结直肠癌侵袭转移的机制研究
411-417 / 7
国家自然科学基金项目(No.82173253)资助
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