局部切除临床 T1 期直肠癌后切缘阳性的预测因素和结果：国家癌症数据库分析。

Predictors and outcomes of positive surgical margins after local excision of clinical T1 rectal cancer: A National Cancer Database analysis.

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Shaare Zedek Medical Center, the Hebrew University Faculty of Medicine, Jerusalem, Israel. Electronic address: https://twitter.com/mikifreund.

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel. Electronic address: https://twitter.com/Nirhoresh1.

出版信息

Surgery. 2023 Jun;173(6):1359-1366. doi: 10.1016/j.surg.2023.02.012. Epub 2023 Mar 21.

DOI:10.1016/j.surg.2023.02.012

PMID:36959073

Abstract

BACKGROUND

Transanal local excision and the use of specialized platforms has become increasingly popular for early-stage rectal cancer. Predictors and outcomes of positive resection margins following transanal local excision for early-stage rectal cancer have yet to be explored.

METHODS

This was a retrospective analysis of the National Cancer Database of all patients with clinical nonmetastatic node negative T1 rectal adenocarcinoma who underwent transanal local excision from 2004 to 2017. Patients with positive surgical margins were compared to those with negative resection margins to determine factors associated with predictors and outcomes of positive surgical margins after transanal local excision. The main outcome measure was overall survival.

RESULTS

Of 318,548 patients with rectal adenocarcinoma in the National Cancer Database, 9,078 (2.8%) met the inclusion criteria. The positive surgical margins rate was 7.4%. Predictors of positive surgical margins were older age (odds ratio, 1.03; P < .001), higher Charlson comorbidity index (odds ratio, 1.24; P = .004), poorly differentiated carcinomas (odds ratio, 1.89; P < .001), mucinous (odds ratio, 2.36; P = .003) and signet-ring cell carcinomas (odds ratio, 4.7; P = .048). Independent predictors of reduced survival were older age (hazard ratio, 1.062; P < .001), male sex (hazard ratio, 1.214; P = .011), Charlson comorbidity index 3 (hazard ratio, 1.94; P < .001), pathologic T2 (hazard ratio, 1.27; P = .036) and T3 stages (hazard ratio, 1.77; P = .006), poorly differentiated carcinomas (hazard ratio, 1.47; P = .008), and positive surgical margins (hazard ratio, 1.374; P = .018). The positive surgical margins group's median overall survival was significantly shorter (88 vs 159.3 months, P < .001).

CONCLUSION

Positive surgical margins after transanal local excision for early-stage node-negative rectal cancer adversely affects prognosis. Older male patients with higher Charlson comorbidity index scores and poorly differentiated mucinous or signet cell histology tumors are at risk for positive surgical margins. Patient selection according to these suggested criteria may help avoid positive surgical margins.

摘要

背景

经肛门局部切除和使用专门平台已越来越多地用于治疗早期直肠癌。经肛门局部切除治疗早期直肠癌后切缘阳性的预测因素和结果仍有待探讨。

方法

这是对 2004 年至 2017 年间全国癌症数据库中所有接受经肛门局部切除治疗的临床非转移性淋巴结阴性 T1 直肠腺癌患者的回顾性分析。将切缘阳性患者与切缘阴性患者进行比较，以确定经肛门局部切除术后切缘阳性的预测因素和结果。主要观察指标为总生存率。

结果

在全国癌症数据库中，318548 例直肠腺癌患者中，有 9078 例（2.8%）符合纳入标准。切缘阳性率为 7.4%。切缘阳性的预测因素包括年龄较大（优势比，1.03；P<.001）、Charlson 合并症指数较高（优势比，1.24；P=.004）、分化程度较差的癌（优势比，1.89；P<.001）、黏液腺癌（优势比，2.36；P=.003）和印戒细胞癌（优势比，4.7；P=.048）。生存时间降低的独立预测因素包括年龄较大（风险比，1.062；P<.001）、男性（风险比，1.214；P=.011）、Charlson 合并症指数 3（风险比，1.94；P<.001）、病理 T2 期（风险比，1.27；P=.036）和 T3 期（风险比，1.77；P=.006）、分化程度较差的癌（风险比，1.47；P=.008）和切缘阳性（风险比，1.374；P=.018）。经肛门局部切除治疗早期淋巴结阴性直肠癌后切缘阳性患者的中位总生存时间明显缩短（88 个月与 159.3 个月，P<.001）。