Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China.
Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu, China; Department of Gerontology, Hospital of Chengdu, Office of People's Government of Tibetan Autonomous Region, Chengdu, China.
Gastrointest Endosc. 2023 Jun;97(6):1016-1030.e14. doi: 10.1016/j.gie.2023.02.027. Epub 2023 Mar 1.
Patients with T1 colorectal cancer (CRC) are at high risk for lymph node metastasis and recurrence after local resection (LR) and need surgical resection (SR) for additional lymph node dissection to improve prognosis. However, the net benefits of SR and LR are still unquantified.
We conducted a systematic search for studies in which survival analysis among high-risk T1 CRC patients undergoing LR and SR was performed. Overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) data were extracted. Hazard ratios (HRs) and fitted survival curves for OS, RFS, and DSS were used to estimate the long-term clinical outcomes of patients in the 2 groups.
This meta-analysis included 12 studies. Compared with those in the SR group, patients in the LR group had higher risks of death (HR, 2.06; 95% confidence interval [CI], 1.59-2.65), recurrence (HR, 3.51; 95% CI, 2.51-4.93), and cancer-related mortality (HR, 2.31; 95% CI, 1.17-4.54) in the long term. Fitted survival curves for the LR and SR groups revealed the 5-year, 10-year, and 20-year rates for OS (86.3% and 94.5%, 72.9% and 84.4%, and 61.8% and 71.1%), RFS (89.9% and 96.9%, 83.3% and 93.9%, and 29.6% and 90.8%), and DSS (96.7% and 98.3%, 86.9% and 97.1%, and 86.9% and 96.4%). Log-rank tests showed significant differences among all outcomes except 5-year DSS.
For high-risk T1 CRC patients, the net benefit of DSS appears to be significant when the observation period exceeds 10 years. A long-term net benefit may exist but may not be applicable to all patients, especially high-risk patients with comorbidities. Therefore, LR may be a reasonable alternative for individualized treatment for some high-risk T1 CRC patients.
T1 结直肠癌（CRC）患者局部切除（LR）后淋巴结转移和复发风险高，需要手术切除（SR）进行额外的淋巴结清扫以改善预后。然而，SR 和 LR 的净获益仍未量化。
我们系统地检索了对接受 LR 和 SR 的高危 T1 CRC 患者进行生存分析的研究。提取总生存（OS）、无复发生存（RFS）和疾病特异性生存（DSS）数据。使用风险比（HR）和拟合的 OS、RFS 和 DSS 生存曲线来估计两组患者的长期临床结局。
本荟萃分析纳入了 12 项研究。与 SR 组相比，LR 组患者死亡（HR，2.06；95%置信区间 [CI]，1.59-2.65）、复发（HR，3.51；95%CI，2.51-4.93）和癌症相关死亡率（HR，2.31；95%CI，1.17-4.54）的风险更高。LR 和 SR 组的拟合生存曲线显示 OS 的 5 年、10 年和 20 年率（86.3%和 94.5%、72.9%和 84.4%和 61.8%和 71.1%）、RFS（89.9%和 96.9%、83.3%和 93.9%和 29.6%和 90.8%）和 DSS（96.7%和 98.3%、86.9%和 97.1%和 86.9%和 96.4%）。对数秩检验显示除 5 年 DSS 外，所有结局均有显著差异。
对于高危 T1 CRC 患者，当观察期超过 10 年时，DSS 的净获益似乎具有显著意义。可能存在长期净获益，但可能不适用于所有患者，尤其是合并症的高危患者。因此，LR 可能是某些高危 T1 CRC 患者个体化治疗的合理选择。
