Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, 2906 ZC, Capelle aan den IJssel, The Netherlands.
Surg Endosc. 2012 Feb;26(2):551-7. doi: 10.1007/s00464-011-1918-4. Epub 2011 Oct 13.
Transanal endoscopic microsurgery (TEM) is considered a curative option for selected T1 rectal cancer. Although TEM is safe, local recurrence (LR) rates after TEM are unacceptably high. Evidence on selection criteria, however, is not abundant. To expand evidence on low- versus high-risk T1 rectal cancer with respect to LR, this study aimed to identify predictive histopathologic factors in a selected group of T1 rectal cancers treated with TEM only.
The study enrolled 62 patients for whom specimens of the primary tumor containing an invasive T1 carcinoma could be reevaluated. Tumors were scored according to predefined criteria, and analysis of predictive factors for locoregional failure was performed.
Local recurrence rates at 3 years for tumors 3 cm in size or smaller were significantly lower than for tumors larger than 3 cm (16 vs. 39%; P < 0.03). Combining smaller tumors with submucosal invasion depth and budding led to identifying tumors that likely will not recur (3-year LR rates, 7 and 10%, respectively).
The findings showed that low- and high-risk criteria are too robust for identifying tumors at risk for LR. Tumor size alone or in combination with submucosal invasion depth or tumor budding appeared to be a significant predictive factor for locoregional failure after TEM for T1 rectal cancer.
经肛门内镜微创手术（TEM）被认为是某些 T1 期直肠癌的一种根治性选择。尽管 TEM 是安全的，但 TEM 后局部复发（LR）率仍高得不可接受。然而，关于选择标准的证据并不充分。为了在 LR 方面扩展关于低风险与高风险 T1 直肠癌的证据，本研究旨在确定一组仅接受 TEM 治疗的 T1 直肠癌患者中具有预测性的组织病理学因素。
本研究纳入了 62 名患者，这些患者的原发性肿瘤标本中包含可重新评估的浸润性 T1 癌。根据预设标准对肿瘤进行评分，并对局部区域失败的预测因素进行分析。
大小为 3cm 或以下的肿瘤 3 年局部复发率明显低于大于 3cm 的肿瘤（16%对 39%；P<0.03）。将较小的肿瘤与黏膜下浸润深度和芽生相结合，可以识别出不太可能复发的肿瘤（3 年 LR 率分别为 7%和 10%）。
这些发现表明，低风险和高风险标准对于识别有 LR 风险的肿瘤过于严格。肿瘤大小单独或与黏膜下浸润深度或肿瘤芽生相结合，似乎是 TEM 治疗 T1 期直肠癌后局部区域失败的一个显著预测因素。
