Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
Oncologist. 2021 Sep;26(9):e1548-e1554. doi: 10.1002/onco.13815. Epub 2021 May 26.
With the implementation of screening programs worldwide, diagnosis of early-stage colorectal cancer steadily increased, including T1 cancer. Current T1 cancer treatment does not differ according to anatomic location. We therefore compared the disease-free survival of T1 cancer arising from the rectum versus the colon.
The hospital-based study included subjects with T1 cancer at National Taiwan University Hospital from 2005 to 2014. Clinical, colonoscopy, and histopathology were reviewed for patients with a mean follow-up time of 7.1 (0.7-12.9) years. We conducted Kaplan-Meier analysis to compare the risk of recurrence by cancer location and Cox regression analysis to identify risk factors for T1 cancer recurrence.
The final cohort included a total of 343 subjects with T1 cancer (mean age, 64.9 ± 11.7 years; 56.1% male), of whom 25 underwent endoscopic resection alone. Of the subjects who underwent surgery, 50 had lymph node metastasis and 268 did not. Kaplan-Meier analysis showed that the risk of recurrence was higher in T1 rectal cancer than T1 colon cancer (p = .022). Rectal location and larger neoplasm size were independent risk factors for recurrence, with hazard ratios of 4.84 (95% confidence interval, 1.18-19.92), and 1.32 (95% confidence interval, 1.06-1.65), respectively. The occurrence of advanced histology did not differ between T1 rectal and colon cancers (p = .58).
T1 cancers arising from the rectum had less favorable recurrence outcomes than those arising from the colon. Further studies are needed to examine whether adjuvant radiotherapy or chemotherapy can reduce the risk of recurrence in T1 rectal cancer.
Current T1 colorectal cancer treatment and surveillance do not differ according to anatomic location. Clinical, colonoscopy, and histopathology were reviewed for 343 patients with T1 cancer with a mean follow-up time of 7.1 years. Kaplan-Meier analysis showed that the risk of recurrence was higher in T1 rectal cancer than T1 colon cancer. Moreover, the rectal location was an independent risk factor for recurrence. T1 cancers from the rectum had less favorable recurrence outcomes than those arising from the colon. It is critical to clarify whether adjuvant therapy or more close surveillance can reduce recurrence risk in T1 rectal cancer.
随着全球范围内筛查计划的实施，早期结直肠癌的诊断包括 T1 期癌症在内稳步增加。目前，T1 期癌症的治疗并不因解剖部位而异。因此，我们比较了直肠和结肠起源的 T1 期癌症的无病生存率。
这项基于医院的研究纳入了 2005 年至 2014 年期间在国立台湾大学医院接受 T1 期癌症治疗的患者。对患者的临床、结肠镜检查和组织病理学资料进行了回顾，平均随访时间为 7.1（0.7-12.9）年。我们通过 Kaplan-Meier 分析比较了癌症部位对复发风险的影响，并通过 Cox 回归分析确定了 T1 期癌症复发的危险因素。
最终纳入了 343 例 T1 期癌症患者（平均年龄 64.9±11.7 岁，56.1%为男性），其中 25 例患者仅接受了内镜下切除术。在接受手术的患者中，50 例患者有淋巴结转移，268 例患者没有淋巴结转移。Kaplan-Meier 分析显示，直肠起源的 T1 期癌症的复发风险高于结肠起源的 T1 期癌症（p=0.022）。直肠部位和肿瘤较大是复发的独立危险因素，风险比分别为 4.84（95%置信区间，1.18-19.92）和 1.32（95%置信区间，1.06-1.65）。直肠和结肠起源的 T1 期癌症的高级别组织学发生情况无差异（p=0.58）。
直肠起源的 T1 期癌症的复发结局不如结肠起源的 T1 期癌症。需要进一步研究辅助放疗或化疗是否能降低 T1 期直肠癌症的复发风险。
目前，T1 期结直肠癌的治疗和监测并不因解剖部位而异。我们对 343 例 T1 期癌症患者的临床、结肠镜检查和组织病理学资料进行了回顾，这些患者的平均随访时间为 7.1 年。Kaplan-Meier 分析显示，直肠起源的 T1 期癌症的复发风险高于结肠起源的 T1 期癌症。此外，直肠部位是复发的独立危险因素。直肠起源的 T1 期癌症的复发结局不如结肠起源的 T1 期癌症。需要明确辅助治疗或更密切的监测是否能降低 T1 期直肠癌症的复发风险。
