Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
Digestion. 2024;105(4):320-330. doi: 10.1159/000538557. Epub 2024 Mar 27.
Non-curative endoscopic resection of T1 colorectal cancer (CRC) carries a substantial risk of recurrence. However, previous studies have reported a significant proportion of cases in which the deep margin of endoscopic resection was positive for cancer due to the technical difficulties of colorectal endoscopic submucosal dissection (ESD). With the advancement of endoscopic technology and techniques resulting in the reduction of positive resection margins, it is important to reassess the long-term prognosis and major risk factors for recurrence in cases of negative deep margins.
We conducted a retrospective cohort study of consecutive patients with T1 CRC who underwent endoscopic resection between January 2006 and December 2021 with negative deep margins. The histological findings of the resected specimens were analyzed to determine the risk factors associated with the primary outcomes of this study, including recurrence and cancer-related deaths.
The median age of the 190 patients was 70 years, of which 63% were male, and endoscopic treatment was performed in 64% by endoscopic mucosal resection and 36% by ESD. Eighty-two patients were in the curative resection (CR) group and 108 were in the non-curative resection (NCR) group, wherein the latter comprised 79 patients who underwent additional surgery (AS) and 29 patients who did not receive AS. Five-year recurrence-free survival rates were 98.4% (95% CI: 89.3-99.8) for CR, 98.3% (95% CI: 88.8-99.8) for NCR with AS, and 73.7% (95% CI: 46.5-88.5) for NCR without AS. Lymphatic invasion and budding grade 2/3 were the major risk factors for recurrence, with hazard ratios of 40.7 (p < 0.001) and 23.1 (p = 0.007), respectively. Of the patients in the NCR group without AS, the 5-year recurrence-free rate was 85.6% (95% CI: 52.5-96.3) if there were no major risk factors (i.e., no lymphatic invasion or budding grade 2/3) (n = 21), whereas the prognosis was poor in the presence of one or more of the major risk factors, with a median recurrence-free survival and disease-specific survival of 2.5 and 3.1 years, respectively (n = 8).
In endoscopically resected T1 CRC with negative deep margins, lymphatic invasion or budding grade 2/3 may indicate a higher risk of recurrence when followed up without AS.
非治愈性内镜切除 T1 结直肠癌（CRC）有很大的复发风险。然而，先前的研究报告称，由于结直肠内镜黏膜下剥离术（ESD）的技术难度，内镜切除的深层边缘有相当比例的癌症阳性病例。随着内镜技术的进步和减少阳性切除边缘，重新评估阴性深层边缘的长期预后和复发的主要危险因素非常重要。
我们对 2006 年 1 月至 2021 年 12 月期间接受内镜切除且深层边缘阴性的连续 T1 CRC 患者进行了回顾性队列研究。分析切除标本的组织学发现，以确定与本研究主要结局相关的危险因素，包括复发和癌症相关死亡。
190 例患者的中位年龄为 70 岁，其中 63%为男性，内镜治疗 64%采用内镜黏膜切除术，36%采用 ESD。82 例患者为治愈性切除（CR）组，108 例为非治愈性切除（NCR）组，其中后者包括 79 例接受辅助手术（AS）的患者和 29 例未接受 AS 的患者。CR 的 5 年无复发生存率为 98.4%（95%CI：89.3-99.8），NCR 伴 AS 为 98.3%（95%CI：88.8-99.8），NCR 无 AS 为 73.7%（95%CI：46.5-88.5）。淋巴管浸润和芽殖分级 2/3 是复发的主要危险因素，风险比分别为 40.7（p < 0.001）和 23.1（p = 0.007）。在 NCR 组中，如果没有主要危险因素（即无淋巴管浸润或芽殖分级 2/3）（n = 21），无 AS 患者的 5 年无复发生存率为 85.6%（95%CI：52.5-96.3），而存在一个或多个主要危险因素时，预后较差，中位无复发生存期和疾病特异性生存期分别为 2.5 年和 3.1 年（n = 8）。
在无 AS 随访的情况下，内镜切除的 T1 CRC 深层边缘阴性且有淋巴管浸润或芽殖分级 2/3 可能提示复发风险较高。
