Department of Gastroenterology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Clin Gastroenterol Hepatol. 2011 Jul;9(7):590-4. doi: 10.1016/j.cgh.2011.02.002. Epub 2011 Feb 12.
BACKGROUND & AIMS: Oncologic surgery is recommended after endoscopic resection of submucosal invasive T1 colorectal carcinomas if patients are considered to be at high risk for tumor recurrence or metastasis. However, there are sparse data on the outcome of high-risk patients treated only by endoscopy.
Data were collected from 474 patients who underwent endoscopic resection for T1 colorectal cancers from 1974-2002 at Neuperlach Hospital in Munich, Germany. Patient files were reviewed, and patients or referring physicians were contacted to assess outcomes during a follow-up period of at least 24 months (n = 390). Histopathology and endoscopy factors associated with an unfavorable outcome (local recurrence of tumors, metastasis, or death from colorectal cancer) were assessed.
Of the 390 patients followed, 141 received oncologic surgery, and 249 did not; overall, 10% had an unfavorable outcome (39/390). Multivariate regression analysis revealed that lymphatic vessel infiltration, poor grading of tumor stage, and incomplete endoscopic resection were risk factors for unfavorable outcomes (odds ratios, 7.8, 3.4, and 2.6, respectively). If these risk factors were applied to patients who did not receive oncologic surgery, negative predictive values for an unfavorable outcome were 94.6% for lymphatic vessel infiltration, 94.2% for poor grading of tumor stage, and 96.5% for incomplete endoscopic resection; positive predictive values were 44.4%, 42.9%, and 19.6%, respectively.
Tumor infiltration of lymphatic vessels is the greatest risk factor for an unfavorable outcome after endoscopic resection for colorectal carcinoma. However, its positive predictive value is low. The decision to perform surgery after endoscopic resection of T1 colorectal cancers should be made on the basis of specific features of each patient.
如果患者被认为有肿瘤复发或转移的高风险，建议对黏膜下浸润性 T1 结直肠肿瘤进行肿瘤外科手术，之后再进行内镜下切除。然而，对于仅接受内镜治疗的高危患者，相关数据较少。
从德国慕尼黑 Neuperlach 医院 1974 年至 2002 年接受内镜下 T1 结直肠癌切除术的 474 例患者中收集数据。回顾患者病历，并联系患者或转诊医生，在至少 24 个月的随访期间评估结果（n=390）。评估与不良结局（肿瘤局部复发、转移或结直肠癌死亡）相关的组织病理学和内镜因素。
在随访的 390 例患者中，141 例接受了肿瘤外科手术，249 例未接受；总体而言，10%（39/390）的患者出现不良结局。多变量回归分析显示，淋巴管浸润、肿瘤分期分级差和内镜下切除不完全是不良结局的危险因素（比值比分别为 7.8、3.4 和 2.6）。如果将这些危险因素应用于未接受肿瘤外科手术的患者，淋巴管浸润、肿瘤分期分级差和内镜下切除不完全的阴性预测值分别为 94.6%、94.2%和 96.5%；阳性预测值分别为 44.4%、42.9%和 19.6%。
淋巴管浸润是内镜下切除结直肠癌后出现不良结局的最大危险因素，但阳性预测值较低。T1 结直肠癌内镜下切除后是否进行手术，应根据每位患者的具体特征来决定。
