Fujii Shoichi, Shimada Ryu, Tsukamoto Mitsuo, Hayama Tamuro, Ishibe Atsushi, Watanabe Jun, Deguchi Takashi, Tsutsumi Kenji, Matsuda Keiji, Hashiguchi Yojiro
Department of Surgery Koga Community Hospital Yaizu Japan.
Department of Surgery Teikyo University School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2020 Nov 11;5(2):228-235. doi: 10.1002/ags3.12407. eCollection 2021 Mar.
Stage II-IV colorectal cancers are subdivided according to TNM categories. However, stage I cases are a single category, despite the inclusion of both T1 and T2 cases, which may have different outcomes. The aim of this study was to evaluate the usefulness of subdividing stage I colorectal cancers by T category.
From 1984 to 2015, 844 patients with stage I colorectal cancer (T1: 446, T2: 398) underwent colorectal resection with lymph node dissection at three hospitals. The long-term survival and recurrence rates were compared between T1 and T2. A Cox regression analysis was used to evaluate the risk factors associated with cancer recurrence.
A comparison of the T1 and T2 groups revealed significant differences in 5-year overall (95.9% vs 91.4%, = .008), recurrence-free (94.8% vs 87.1%, = .0007), and cancer-specific survival (97.6% vs 93.6%, = .004), and in the overall (2.5% vs 6.8%, = .003), local (0.2% vs 1.5%, = .04), and lymph node recurrence rates (0.2% vs 1.5%, = .04). All local and lymph node recurrences were associated with lower rectal cancer, and this difference was significant. The Cox multivariate analysis identified male sex ( = .01, hazard ratio: 4.00, 95% confidence interval: 1.38-11.55), T2 ( = .02, hazard ratio: 2.98, 95% confidence interval: 1.17-7.60), and venous invasion ( = .03, hazard ratio: 2.38, 95% confidence interval: 1.12-5.10) as risk factors for recurrence.
The subdivision of stage I colorectal cancer according to T category clearly reflected the long-term outcomes.
II-IV期结直肠癌根据TNM分类进行细分。然而，I期病例是单一类别，尽管包含T1和T2病例，但其预后可能不同。本研究的目的是评估根据T分期对I期结直肠癌进行细分的实用性。
1984年至2015年，844例I期结直肠癌患者（T1：446例，T2：398例）在三家医院接受了结直肠癌切除及淋巴结清扫术。比较T1和T2患者的长期生存率和复发率。采用Cox回归分析评估与癌症复发相关的危险因素。
T1组和T2组比较显示，5年总生存率（95.9%对91.4%，P = 0.008）、无复发生存率（94.8%对87.1%，P = 0.0007）和癌症特异性生存率（97.6%对93.6%，P = 0.004），以及总复发率（2.5%对6.8%，P = 0.003）、局部复发率（0.2%对1.5%，P = 0.04）和淋巴结复发率（0.2%对1.5%，P = 0.04）存在显著差异。所有局部和淋巴结复发均与低位直肠癌相关，且这种差异具有统计学意义。Cox多因素分析确定男性（P = 0.01，风险比：4.00，95%置信区间：1.38-11.55）、T2（P = 0.02，风险比：2.98，95%置信区间：1.17-7.60）和静脉侵犯（P = 0.03，风险比：2.38，95%置信区间：1.12-5.10）为复发的危险因素。
根据T分期对I期结直肠癌进行细分能清楚地反映长期预后。
