Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5066, USA.
Cancer. 2012 Feb 1;118(3):651-9. doi: 10.1002/cncr.26340. Epub 2011 Jul 12.
The management of colon polyps containing invasive carcinoma includes surgical resection or colonoscopic polypectomy. To date, there are very limited population-based data comparing outcomes with the 2 management approaches.
Using the linked Surveillance Epidemiology and End Results-Medicare database, we identified 2077 patients aged ≥66 years with an initial diagnosis of stage T1N0M0 malignant polyp from 1992-2005. Patients were categorized as surgical or polypectomy depending on the most invasive treatment. To adjust for potential selection bias in treatment assignment, using multivariate analysis, patients were divided into quintiles of likelihood of polypectomy (propensity scores), and outcomes were compared in each quintile.
Surgical resection was performed in 1340 (64.5%) patients and polypectomy was performed in 737 (35.5%) patients. Predictors for undergoing polypectomy (P<.001) included older age, greater comorbidity, no history of polyps, diagnosis in 2002 or later, left colon site of cancer, well-differentiated tumors, and colonoscopy performed in an outpatient setting. Both 1-year and 5-year survival were higher in the surgical group (92% and 75%, respectively) than in the polypectomy group (88% and 62%, respectively). The unadjusted hazard ratio was 1.51 (95% confidence interval [CI], 1.31-1.74). After adjusting for propensity quintile, the hazard ratio was 1.15 (95% CI, 0.98-1.33). Within each propensity quintile, the risk of death was similar between the 2 groups (interaction test P = .96).
In this large, population-based sample, more than one-third of patients with malignant polyps were treated with colonoscopic polypectomy. Outcomes were similar to surgical patients with comparable clinical characteristics and could be offered to patients who meet appropriate clinical criteria.
含有浸润性癌的结肠息肉的治疗包括手术切除或结肠镜息肉切除术。迄今为止，比较这两种治疗方法的结果的人群数据非常有限。
使用链接的监测、流行病学和最终结果-医疗保险数据库，我们从 1992 年至 2005 年确定了 2077 名年龄≥66 岁、初始诊断为 T1N0M0 期恶性息肉的患者。根据最具侵袭性的治疗方法，将患者分为手术或息肉切除术。为了调整治疗分配中潜在的选择偏倚，使用多变量分析，将患者分为息肉切除术可能性的五分位数（倾向评分），并在每个五分位数中比较结果。
1340 例（64.5%）患者接受了手术切除，737 例（35.5%）患者接受了息肉切除术。接受息肉切除术的预测因素（P<.001）包括年龄较大、合并症较多、无息肉史、2002 年或以后诊断、左结肠癌、分化良好的肿瘤以及在门诊进行结肠镜检查。手术组的 1 年和 5 年生存率均高于息肉切除术组（分别为 92%和 75%）。未调整的危险比为 1.51（95%置信区间[CI]，1.31-1.74）。在调整倾向五分位数后，危险比为 1.15（95% CI，0.98-1.33）。在每个倾向五分位数内，两组之间的死亡风险相似（交互检验 P =.96）。
在这项大型基于人群的样本中，超过三分之一的恶性息肉患者接受了结肠镜息肉切除术治疗。对于符合适当临床标准的患者，可以提供与具有相似临床特征的手术患者相似的结果。
