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。
Introduction There is considerable concern about whether endoscopic resection(ER)prior to additional surgery(AS)for T1 colorectal cancer(CRC)has oncologically potential adverse effects.Therefore,this study aimed to compare the long-term outcomes,including overall survival(OS),of patients treated with AS after ER versus primary surgery(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 recurrence 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.
作者
张博翔
李建男
Zhang Boxiang;Li jiannan
出处
《结直肠肛门外科》
2024年第4期479-480,485,共3页
Journal of Colorectal & Anal Surgery
关键词
T1期
结直肠癌
总体生存
复发
内镜切除
T1
colorectal cancer
overall survival
recurrence
endoscopic resection
