Luo Xinyue, Chen Yuxiang, Yang Jinlin, Deng Kai, Wu Junchao, Gan Tao
（ 610041） Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2024 Mar 20;55(2):411-417. doi: 10.12182/20240360502.
To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.
The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected. The patients were divided into the endoscopic resection (ER) plus additional surgical resection (SR) group, or the ER+SR group, and the ER group according to whether additional SR were performed after ER. Baseline data of the patients and information on the location, size, and postoperative pathology of the lesions were collected. Patient survival-related information was obtained through the medical record system and patient follow-up. The primary outcome indicators were the overall survival and the colorectal cancer-specific survival. Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio () was calculated. Multivariate Cox regression analysis was used to analyze the independent influencing factors.
The data of 109 patients with T1 high-risk colorectal cancer were collected, with 52 patients in the ER group and 57 patients in the ER+SR group. The mean age of patients in the ER group was higher than that in the ER+SR group (65.21 years old vs. 60.54 years old, =0.035), and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group (2.00 cm vs. 2.50 cm, =0.026). The median follow-up time was 30.00 months, with the maximum follow-up time being 119 months, in the ER+SR group and there were 4 patients deaths, including one colorectal cancer-related death. Whereas the median follow-up time in the ER group was 28.50 months, with the maximum follow-up time being 78.00 months, and there were 4 patient deaths, including one caused by colorectal cancer. The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44% and 81.65%, respectively, and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18% and 98.06%, respectively. The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups. Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival (=1.16 and =0.27, respectively), with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis (=1.10, =0.045).
For T1 colorectal cancer patients with high risk factors after ER, factors such as patient age and their personal treatment decisions should not be overlooked. In clinical practice, additional caution should be exercised in decision-making concerning additional surgery.
分析追加手术对接受内镜切除的高危T1期结直肠癌患者生存及预后的影响。
回顾性收集高危T1期结直肠癌患者的临床资料。根据内镜切除（ER）后是否进行追加手术切除（SR），将患者分为ER联合追加手术切除组（ER+SR组）和ER组。收集患者的基线数据以及病变的位置、大小和术后病理信息。通过病历系统和患者随访获取患者生存相关信息。主要结局指标为总生存和结直肠癌特异性生存。采用单因素Cox回归分析筛选生存相关危险因素并计算风险比（HR）。采用多因素Cox回归分析分析独立影响因素。
收集到109例T1期高危结直肠癌患者的数据，其中ER组52例，ER+SR组57例。ER组患者的平均年龄高于ER+SR组（65.21岁 vs. 60.54岁，P=0.035），ER组病变内镜测量大小的中位数略低于ER+SR组（2.00 cm vs. 2.50 cm，P=0.026）。ER+SR组的中位随访时间为30.00个月，最长随访时间为119个月，有4例患者死亡，其中1例与结直肠癌相关。而ER组的中位随访时间为28.50个月，最长随访时间为78.00个月，有4例患者死亡，其中1例由结直肠癌导致。ER+SR组和ER组的5年总累积生存率分别为94.44%和81.65%，ER+SR组和ER组的癌症特异性5年累积生存率分别为97.18%和98.06%。Kaplan-Meier分析显示，ER+SR组和ER组的总累积生存或癌症特异性累积生存无显著差异。单因素Cox回归分析显示，年龄和复查次数是总生存的危险因素（HR分别为1.16和0.27），多因素Cox回归分析确定年龄为总生存的独立危险因素（HR=1.10，P=0.045）。
对于ER后具有高危因素的T1期结直肠癌患者，患者年龄及其个人治疗决策等因素不容忽视。在临床实践中，在决定是否进行追加手术时应格外谨慎。
