75岁及以上患者结直肠肿瘤内镜黏膜下剥离术的预后因素及长期结局
Prognostic factors and long-term outcomes with endoscopic submucosal dissection for colorectal tumors in patients aged 75 years or older.
作者信息
Miura Takaya, Matsumoto Satohiro, Sato Azumi, Kojima Shu, Sasaki Goya, Morino Mina, Matsumoto Keita, Kashima Hitomi, Koito Yudai, Ishii Takehiro, Yoshikawa Shuhei, Otake Haruka, Uehara Takeshi, Sekine Masanari, Asano Takeharu, Miyatani Hiroyuki, Mashima Hirosato
机构信息
Department of Gastroenterology Jichi Medical University Saitama Medical Center Saitama Japan.
出版信息
DEN Open. 2025 May 6;6(1):e70137. doi: 10.1002/deo2.70137. eCollection 2026 Apr.
BACKGROUND
Studies regarding the long-term outcomes of endoscopic submucosal dissection (ESD) performed in older patients with colorectal tumors are limited. Therefore, in this study, we aimed to analyze the long-term outcomes of older patients with colorectal tumors who underwent ESD and identify prognostic factors.
METHODS
The data of patients aged ≥ 75 years who underwent ESD for colorectal tumors (adenoma and Tis/T1 colorectal cancer) at a single center were retrospectively analyzed. Prognostic factors for overall survival were analyzed using the Kaplan-Meier method and the Cox proportional hazard model.
RESULTS
Of the 156 patients included, 51 patients died during the follow-up period, among whom two deaths were due to colorectal cancer. The univariate analysis revealed that an age ≥83 years, Charlson Comorbidity Index ≥2, prognostic nutritional index <46, and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with poor overall survival. The multivariate analysis identified Charlson Comorbidity Index ≥2 (hazard ratio: 2.26; 95% confidence interval (CI): 1.24-4.13; = 0.0008) and NLR ≥3 (hazard ratio, 1.98; 95% CI: 1.02-3.81; = 0.042) as independent prognostic factors.
CONCLUSIONS
CCI and NLR may be useful parameters for decision-making in older patients undergoing colorectal ESD.
背景
关于老年结直肠肿瘤患者接受内镜黏膜下剥离术（ESD）的长期预后的研究有限。因此，在本研究中，我们旨在分析接受ESD的老年结直肠肿瘤患者的长期预后，并确定预后因素。
方法
回顾性分析在单一中心接受ESD治疗结直肠肿瘤（腺瘤和Tis/T1期结直肠癌）的年龄≥75岁患者的数据。使用Kaplan-Meier法和Cox比例风险模型分析总生存的预后因素。
结果
在纳入的156例患者中，51例患者在随访期间死亡，其中2例死于结直肠癌。单因素分析显示，年龄≥83岁、Charlson合并症指数≥2、预后营养指数<46以及中性粒细胞与淋巴细胞比值（NLR）≥3与总生存不良相关。多因素分析确定Charlson合并症指数≥2（风险比：2.26；95%置信区间（CI）：1.24 - 4.13；P = 0.0008）和NLR≥3（风险比，1.98；95%CI：1.02 - 3.81；P = 0.042）为独立预后因素。
结论
CCI和NLR可能是老年结直肠ESD患者决策中的有用参数。
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