Nilsson Emelie, Wetterholm Erik, Syk Ingvar, Thorlacius Henrik, Rönnow Carl-Fredrik
Department of Clinical Sciences, Division of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
BJS Open. 2024 May 8;8(3). doi: 10.1093/bjsopen/zrae053.
Endoscopic resection of T1 colon cancer (CC) is currently limited by guidelines related to risk of lymph node metastases. However, clinical outcome following endoscopic and surgical resection is poorly investigated.
A retrospective multicentre national cohort study was conducted on prospectively collected data from the Swedish colorectal cancer registry on all non-pedunculated T1 CC patients undergoing surgical and endoscopic resection between 2009 and 2021. Patients were categorized on the basis of deep submucosal invasion (Sm2-3), lymphovascular invasion (LVI), poor tumour differentiation, and R1/Rx into low- and high-risk cases. The primary outcomes of interest were recurrence rates and disease-free interval (DFI, defined as time from treatment to date of recurrence) according to resection methods and risk factors (sex, age at diagnosis, histologic grade, LVI, perineural invasion, mucinous subtype, submucosal invasion, tumour location, resection margin and nodal positivity in the surgical group).
In total, 1805 patients undergoing endoscopic (488) and surgical (1317) resection with 60.0 months median follow-up were included. Recurrence occurred in 18 (3.7%) endoscopically and 48 (3.6%) surgically resected patients. Adjuvant treatment was administered in 7.4% and 0.2% of the cases respectively in the surgical and endoscopically treated patients. Five-year DFI was 95.6% after endoscopic and 96.2% after surgical resection, with no significant difference when adjusting for confounding factors (HR 1.03, 95% c.i. 0.56 to 1.91, P = 0.920). There were no statistically significant differences in recurrence comparing endoscopic (1.7%) versus surgical (3.6%) low-risk and endoscopic (5.4%) versus surgical (3.8%) high-risk cases. LVI was the only significant risk factor for recurrence in multivariate Cox regression (HR 3.73, 95% c.i. 1.76 to 7.92, P < 0.001).
This study shows no difference in recurrence after endoscopic and surgical resection in high-risk T1 CC. Although it was not possible to match groups according to treatment, the multivariate analysis showed that lymphovascular invasion was the only independent risk factor for recurrence.
目前，T1期结肠癌（CC）的内镜切除受淋巴结转移风险相关指南限制。然而，内镜切除与手术切除后的临床结局鲜有研究。
对瑞典结直肠癌登记处前瞻性收集的2009年至2021年间所有接受手术和内镜切除的无蒂T1期CC患者的数据进行一项回顾性多中心全国队列研究。根据深层黏膜下浸润（Sm2-3）、淋巴管浸润（LVI）、肿瘤分化差以及R1/Rx将患者分为低风险和高风险病例。主要关注的结局是根据切除方法和风险因素（性别、诊断时年龄、组织学分级、LVI、神经周围浸润、黏液亚型、黏膜下浸润、肿瘤位置、手术组的切缘和淋巴结阳性情况）得出的复发率和无病间期（DFI，定义为从治疗到复发日期的时间）。
总共纳入了1805例接受内镜（488例）和手术（1317例）切除的患者，中位随访时间为60.0个月。内镜切除患者中有18例（3.7%）复发，手术切除患者中有48例（3.6%）复发。手术治疗和内镜治疗患者中分别有7.4%和0.2%的病例接受了辅助治疗。内镜切除后五年无病间期为95.6%，手术切除后为96.2%，调整混杂因素后无显著差异（风险比1.03，95%置信区间0.56至1.91，P = 0.920）。在内镜（1.7%）与手术（3.6%）低风险病例以及内镜（5.4%）与手术（3.8%）高风险病例的复发情况比较中，均无统计学显著差异。在多变量Cox回归分析中，LVI是复发的唯一显著风险因素（风险比3.73，95%置信区间1.76至7.92，P < 0.001）。
本研究表明，高风险T1期CC患者内镜切除与手术切除后的复发情况无差异。尽管无法根据治疗方法对组进行匹配，但多变量分析显示，淋巴管浸润是复发的唯一独立风险因素。
