摘要
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 obser-vation.We compared the long-term outcomes of these approaches with the aim of clarifying the need for additional re-section.Method This multicentre retrospective study included high-risk T1 colorectal cancer patients treated with endo-scopic submucosal dissection(ESD)between January 2013 and April 2021.Patients who met one or more of the follow-ing criteria were eligible for inclusion:submucosal invasion depth ≥ 1,000 μm,vessel invasion,poor differentiation,bud-ding grade 2/3 or a positive vertical margin.Patients were divided into resection(R)and observation(O)groups.Out-comes were evaluated based on overall survival(OS)and 5-year cancer-specific survival(CSS),with an additional strati-fied 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).Con-clusions Significant survival benefits were demonstrated in group R patients with high-risk T1 cancer.However,the sur-vival benefit of additional surgical resection was unconfirmed in patients with ACCI ≥ 7.关键词
高风险T1期结直肠癌/内镜下黏膜剥离术/肿瘤学结局/年龄校正Charlson合并症指数/结直肠癌治疗策略Key words
high-risk T1 colorectal cancer/endoscopic submucosal dissection/oncological outcomes/age-adjusted Charlson comorbidity index/therapeutic strategies in colorectal cancer分类
临床医学
