Verseveld M, Verver D, Noordman B J, Pouwels S, Elferink M A G, de Graaf E J R, Verhoef C, Doornebosch P G, de Wilt J H W
Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, the Netherlands; Department of Surgery, division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, the Netherlands.
Eur J Surg Oncol. 2022 May;48(5):1153-1160. doi: 10.1016/j.ejso.2021.11.002. Epub 2021 Nov 13.
Local excision is increasingly used as an alternative treatment for radical surgery in patients with early stage clinical T1 (cT1) rectal cancer. This study provides an overview of incidence, staging accuracy and treatment strategies in patients with cT1 rectal cancer in the Netherlands.
Patients with cT1 rectal cancer diagnosed between 2005 and 2018 were included from the Netherlands Cancer Registry. An overview per time period (2005-2009, 2010-2014 and 2015-2018) of the incidence and various treatment strategies used, e.g. local excision (LE) or major resection, with/without neoadjuvant treatment (NAT), were given and trends over time were analysed using the Chi Square for Trend test. In addition, accuracy of tumour staging was described, compared and analysed over time.
In total, 3033 patients with cT1 rectal cancer were diagnosed. The incidence of cT1 increased from 540 patients in 2005-2009 to 1643 patients in 2015-2018. There was a significant increased use of LE. In cT1N0/X patients, 9.2% received NAT, 25.5% were treated by total mesorectal excision (TME) and 11.4% received a completion TME (cTME) following prior LE. Overall accuracy in tumour staging (cT1 = pT1) was 77.3%, yet significantly worse in cN1/2 patients, as compared to cN0 patients (44.8% vs 77.9%, respectively, p < 0.001).
Over time, there was an increase in the incidence of cT1 tumours. Both the use of neoadjuvant therapy and TME surgery in clinically node negative patients decreased significantly. Clinical accuracy in T1 tumour staging improved over time, but remained significantly worse in clinical node positive patients.
局部切除越来越多地被用作早期临床T1（cT1）直肠癌患者根治性手术的替代治疗方法。本研究概述了荷兰cT1直肠癌患者的发病率、分期准确性及治疗策略。
纳入荷兰癌症登记处2005年至2018年诊断的cT1直肠癌患者。给出每个时间段（2005 - 2009年、2010 - 2014年和2015 - 2018年）的发病率及所采用的各种治疗策略，如局部切除（LE）或大手术切除，有无新辅助治疗（NAT），并使用趋势卡方检验分析随时间的趋势。此外，描述、比较并分析肿瘤分期随时间的准确性。
共诊断出3033例cT1直肠癌患者。cT1的发病率从2005 - 2009年的540例增加到2015 - 2018年的1643例。LE的使用显著增加。在cT1N0/X患者中，9.2%接受了NAT，25.5%接受了全直肠系膜切除术（TME），11.4%在先前LE后接受了补充TME（cTME）。肿瘤分期（cT1 = pT1）的总体准确率为77.3%，但与cN0患者相比，cN1/2患者的准确率显著更低（分别为44.8%和77.9%，p < 0.001）。
随着时间推移，cT1肿瘤的发病率有所增加。临床淋巴结阴性患者中，新辅助治疗和TME手术的使用均显著减少。T1肿瘤分期的临床准确性随时间有所提高，但临床淋巴结阳性患者的准确性仍显著更低。
