Sasaki Ben, Yamada Masahiro, Mishima Yusuke, Ohmine Takahito, Tani Masaki, Sato Asahi, Toda Kosuke, Yazawa Takefumi, Ohe Hidenori, Yamanaka Kenya
Surgery, Shiga General Hospital, Moriyama, JPN.
Cureus. 2024 Dec 24;16(12):e76333. doi: 10.7759/cureus.76333. eCollection 2024 Dec.
Objective This study aims to investigate the risk factors for lymph node metastasis (LNM) and postoperative recurrence in patients undergoing surgery for pT1 colorectal cancer (pT1-CRC). Materials and methods We retrospectively analyzed 150 patients who underwent bowel resection with lymph node dissection for pT1-CRC at our department between September 2011 and December 2021. Univariate and multivariate analyses were performed to examine the effects of sex, depth of tumor invasion, venous invasion, lymphatic invasion, tumor budding (BD), and histological type on LNM and recurrence. We analyzed recurrence-free survival (RFS) curves. Results LNM was observed in 21 (14.0%) patients. Univariate analysis identified female sex, undifferentiated histological type, positive lymphatic invasion, and tumor budding grade 2/3 (BD2/3) as significant risk factors for LNM, whereas multivariate analysis identified female sex, undifferentiated histological type, and BD2/3 as independent risk factors. No cancer-related deaths were observed during the median observation period of 60.7 months. The five-year RFS rate differed significantly between LNM- and LNM+ patients, at 97.3% and 66.4%, respectively (p=0.0005). BD2/3 was also the significant risk factor for recurrence in the univariate analysis (p<0.0001). In LNM- patients, the five-year RFS was 98.7% for BD1 and 88.2% for BD2/3 (p=0.0014), while in LNM+ patients, it was 100% for BD1 and 37.0% for BD2/3 (p=0.036), with significant differences observed. Conclusion In pT1-CRC patients, female sex, undifferentiated histological type, and BD2/3 were the risk factors for LNM. The recurrence rate was higher in patients with LNM than in those without LNM. Regardless of LNM, BD2/3 was the risk factor for the postoperative recurrence of pT1-CRC.
目的 本研究旨在探讨pT1期结直肠癌（pT1-CRC）手术患者发生淋巴结转移（LNM）及术后复发的危险因素。材料与方法 我们回顾性分析了2011年9月至2021年12月期间在我科接受pT1-CRC肠切除并淋巴结清扫术的150例患者。进行单因素和多因素分析，以检验性别、肿瘤浸润深度、静脉侵犯、淋巴管侵犯、肿瘤芽生（BD）和组织学类型对LNM和复发的影响。我们分析了无复发生存（RFS）曲线。结果 21例（14.0%）患者出现LNM。单因素分析确定女性、未分化组织学类型、淋巴管侵犯阳性和肿瘤芽生2/3级（BD2/3）为LNM的显著危险因素，而多因素分析确定女性、未分化组织学类型和BD2/3为独立危险因素。在60.7个月的中位观察期内未观察到癌症相关死亡。LNM患者和非LNM患者的五年RFS率差异显著，分别为97.3%和66.4%（p = 0.0005）。BD2/3在单因素分析中也是复发的显著危险因素（p < 0.0001）。在无LNM患者中，BD1的五年RFS为98.7%，BD2/3为88.2%（p = 0.0014），而在有LNM患者中，BD1为100%，BD2/3为37.0%（p = 0.036），差异显著。结论 在pT1-CRC患者中，女性、未分化组织学类型和BD2/3是LNM的危险因素。有LNM的患者复发率高于无LNM的患者。无论有无LNM，BD2/3都是pT1-CRC术后复发的危险因素。
