Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
Arizona Center for Digestive Health, Gilbert, Arizona, USA.
Gastrointest Endosc. 2015 Mar;81(3):733-740.e2. doi: 10.1016/j.gie.2014.11.049.
Long-term population-based data comparing endoscopic therapy (ET) and surgery for management of malignant colorectal polyps (MCPs) are limited.
To compare colorectal cancer (CRC)-specific survival with ET and surgery.
Population-based study.
Patients with stage 0 and stage 1 MCPs were identified from the Surveillance Epidemiology and End Results (SEER) database (1998-2009). Demographic characteristics, tumor size, location, treatment modality, and survival were compared. Propensity-score matching and Cox proportional hazards regression models were used to evaluate the association between treatment and CRC-specific survival.
ET and surgery.
Mid-term (2.5 years) and long-term (5 years) CRC-free survival rates and independent predictors of CRC-specific mortality.
Of 10,403 patients with MCPs, 2688 (26%) underwent ET and 7715 (74%) underwent surgery. Patients undergoing ET were more likely to be older white men with stage 0 disease. Surgical patients had more right-sided lesions, larger MCPs, and stage 1 disease. There was no difference in the 2.5-year and 5-year CRC-free survival rates between the 2 groups in stage 0 disease. Surgical resection led to higher 2.5-year (97.8% vs 93.2%; P < .001) and 5-year (96.6% vs 89.8%; P < .001) CRC-free survival in stage 1 disease. These results were confirmed by propensity-score matching. ET was a significant predictor for CRC-specific mortality in stage 1 disease (hazard ratio 2.40; 95% confidence interval, 1.75-3.29; P < .001).
Comorbidity index not available, selection bias.
ET and surgery had comparable mid- and long-term CRC-free survival rates in stage 0 disease. Surgical resection is the recommended treatment modality for MCPs with submucosal invasion.
长期的基于人群的数据比较内镜治疗（ET）和手术治疗恶性结直肠息肉（MCP）的效果有限。
比较 ET 和手术治疗结直肠癌（CRC）特异性生存。
基于人群的研究。
从监测、流行病学和最终结果（SEER）数据库（1998-2009 年）中确定 0 期和 1 期 MCP 患者。比较人口统计学特征、肿瘤大小、位置、治疗方式和生存情况。采用倾向评分匹配和 Cox 比例风险回归模型评估治疗与 CRC 特异性生存之间的关系。
ET 和手术。
中期（2.5 年）和长期（5 年）CRC 无复发生存率以及 CRC 特异性死亡率的独立预测因素。
在 10403 例 MCP 患者中，2688 例（26%）接受了 ET，7715 例（74%）接受了手术。接受 ET 的患者更有可能是 0 期疾病的老年白人男性。手术组患者的病变更偏右侧，肿瘤更大，疾病分期为 1 期。在 0 期疾病中，两组 2.5 年和 5 年 CRC 无复发生存率无差异。手术切除可显著提高 2.5 年（97.8%比 93.2%；P <.001）和 5 年（96.6%比 89.8%；P <.001）CRC 无复发生存率，这一结果在倾向评分匹配后仍然成立。ET 是 1 期疾病 CRC 特异性死亡的显著预测因素（风险比 2.40；95%置信区间，1.75-3.29；P <.001）。
无法获取合并症指数，存在选择偏倚。
ET 和手术在 0 期疾病中具有相似的中期和长期 CRC 无复发生存率。对于黏膜下侵犯的 MCP，手术切除是推荐的治疗方法。
