Department of Gastroenterology, University Hospital, 35033, Rennes, France.
Rennes 1 University, 35000, Rennes, France.
Dig Liver Dis. 2020 Aug;52(8):909-917. doi: 10.1016/j.dld.2020.04.022. Epub 2020 Jun 3.
The main aim of this study was to examine the management strategies that were used and to determine the outcomes (survival and recurrence rate) of screen-detected T1-CRC.
Medical records from 207 patients with T1-CRC diagnosed through the French national screening programme in one district from 2003 to 2015 were analysed. The 5-year overall, CRC-specific and CRC-free survival were calculated for the whole cohort and for the 3 groups treated by endoscopic resection (ER) alone, ER followed by subsequent surgery (ERSS), and primary surgery (PS).
Of the 207 patients, 81 (39%) underwent PS, and 126 (61%) underwent primary ER, of whom 82 (64%) underwent subsequent surgery. The 5-year overall and cancer-specific survival rates were 95.5% (95% CI, 90.8; 97.9) and 98.8% (95% CI, 95.4; 99.7%), respectively. Long-term cancer-specific mortality and recurrence crude rates were 2.4% and 5.6%, respectively. The 5-year CRC-free survival rate was 96.1% (95% CI, 91.8; 98.1%) and did not differ amongst the 3 groups (ER alone, ERSS and PS).
This study demonstrates the good prognosis of screen-detected T1-CRC, regardless of the treatment strategy used. But, there is a room to improve the screening programme quality with regard to the management of screen-detected CRC.
本研究的主要目的是研究所采用的治疗策略，并确定经法国全国筛查计划筛查出的 T1-CRC 的结局（生存率和复发率）。
分析了 2003 年至 2015 年间一个地区通过法国全国筛查计划诊断为 T1-CRC 的 207 例患者的病历。计算了整个队列以及仅行内镜下切除（ER）、ER 后行后续手术（ERSS）和直接手术（PS）治疗的 3 组患者的 5 年总生存率、结直肠癌特异性生存率和无结直肠癌生存率。
207 例患者中，81 例（39%）行 PS，126 例（61%）行原发性 ER，其中 82 例（64%）行后续手术。5 年总生存率和癌症特异性生存率分别为 95.5%（95%CI，90.8；97.9）和 98.8%（95%CI，95.4；99.7%）。长期癌症特异性死亡率和复发率分别为 2.4%和 5.6%。5 年无结直肠癌生存率为 96.1%（95%CI，91.8；98.1%），3 组之间无差异（ER 单独组、ERSS 组和 PS 组）。
本研究表明，无论采用何种治疗策略，经筛查发现的 T1-CRC 预后良好。但是，在管理经筛查发现的结直肠癌方面，还有改进筛查计划质量的空间。
