恶性 T1 结直肠息肉的处理：一项 10 年前瞻性观察研究的结果。

Management of malignant T1 colorectal cancer polyps: results from a 10-year prospective observational study.

机构信息

Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK.

Department of Coloproctology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.

出版信息

Colorectal Dis. 2023 Oct;25(10):1960-1972. doi: 10.1111/codi.16716. Epub 2023 Aug 23.

DOI:10.1111/codi.16716

PMID:37612791

Abstract

AIM

The recurrence risk associated with residual malignant cells (bowel wall/regional nodes) following T1 colorectal cancer (CRC) polypectomy must be weighed against operative morbidity. Our aim was to describe the management and outcomes of a large prospective cohort of T1 CRCs.

METHOD

All T1 CRCs diagnosed between March 2007 and March 2017 at the Glasgow Royal Infirmary were included. Patients were grouped by polypectomy, rectal local excision and formal resection status. χ testing, multivariate binary logistic and Cox regression were performed.

RESULTS

Of 236 patients, 90 (38.1%) underwent polypectomy only, six (2.6%) polypectomy and then rectal excision, 57 (24.2%) polypectomy and then resection, 14 (5.9%) rectal excision only and 69 (29.2%) primary resection. Polypectomy only correlated with male sex (P = 0.028), older age (P < 0.001), distal CRCs (P < 0.001) and pedunculated polyps (P < 0.001); primary resection with larger polyps (P < 0.001); polypectomy then resection with piecemeal excision (P = 0.002) and involved polypectomy margin (P < 0.001). Poor differentiation (OR 7.860, 95% CI 1.117-55.328; P = 0.038) independently predicted lymph node involvement. Submucosal venous invasion (hazard ratio [HR] 10.154, 95% CI 2.087-49.396; P = 0.004) and mucinous subtype (HR 7.779, 95% CI 1.566-38.625; P = 0.012) independently predicted recurrence. Submucosal venous invasion (HR 5.792, 95% CI 1.056-31.754; P = 0.043) predicted CRC-specific survival. Although 64.4% of polypectomy-only patients had margin involvement/other risk factors, none developed recurrence. Of 94 with polypectomy margin involvement, five (5.3%) had confirmed residual tumour. Overall, lymph node metastases (7.1%), recurrence (4.2%) and cancer-specific mortality (3.0%) were rare. Cancer-specific 5-year survival was high: polypectomy only (100%), polypectomy and then resection (98.2%), primary resection (100%).

CONCLUSION

Surveillance may be safe for more T1 CRC polyp patients. Multidisciplinary team discussion and informed patient choice are critical.

摘要

目的

在 T1 结直肠癌（CRC）息肉切除术后，与手术发病率相关的残留恶性细胞（肠壁/区域淋巴结）的复发风险必须加以权衡。我们的目的是描述一组大型 T1 CRC 的前瞻性队列的管理和结果。

方法

所有 2007 年 3 月至 2017 年 3 月在格拉斯哥皇家医院诊断的 T1 CRC 患者均纳入研究。根据息肉切除术、直肠局部切除术和正式切除术的情况对患者进行分组。采用 χ2 检验、多变量二项逻辑回归和 Cox 回归进行分析。

结果

236 例患者中，90 例（38.1%）仅行息肉切除术，6 例（2.6%）行息肉切除术加直肠切除术，57 例（24.2%）行息肉切除术加切除术，14 例（5.9%）仅行直肠切除术，69 例（29.2%）行原发性切除术。仅行息肉切除术与男性（P=0.028）、年龄较大（P<0.001）、远端 CRC（P<0.001）和带蒂息肉（P<0.001）相关；原发性切除术与较大的息肉相关（P<0.001）；息肉切除术加切除术与分片切除（P=0.002）和累及息肉边缘（P<0.001）相关。分化不良（OR 7.860，95%CI 1.117-55.328；P=0.038）独立预测淋巴结受累。黏膜下静脉侵犯（HR 10.154，95%CI 2.087-49.396；P=0.004）和黏液型亚型（HR 7.779，95%CI 1.566-38.625；P=0.012）独立预测复发。黏膜下静脉侵犯（HR 5.792，95%CI 1.056-31.754；P=0.043）预测 CRC 特异性生存。尽管 64.4%的仅行息肉切除术患者有边缘受累/其他危险因素，但无一人发生复发。94 例有息肉切除术边缘受累的患者中，有 5 例（5.3%）证实有残留肿瘤。总体而言，淋巴结转移（7.1%）、复发（4.2%）和癌症特异性死亡率（3.0%）罕见。癌症特异性 5 年生存率较高：仅行息肉切除术（100%）、息肉切除术加切除术（98.2%）、原发性切除术（100%）。