省略局部切除后的进一步手术如何影响高危T1结直肠癌患者的预后结果？
How Does Omitting Additional Surgery after Local Excision Affect the Prognostic Outcome of Patients with High-risk T1 Colorectal Cancer?
发表日期：2023 Sep 05
作者：
Akira Ouchi, Koji Komori, Tajika Masahiro, Kazuhiro Toriyama, Yoshiki Kajiwara, Shiro Oka, Yosuke Fukunaga, Kinichi Hotta, Hiroaki Ikematsu, Shunsuke Tsukamoto, Shinji Nagata, Kazutaka Yamada, Maki Konno, Soichiro Ishihara, Yusuke Saitoh, Kenji Matsuda, Kazutomo Togashi, Megumi Ishiguro, Toshio Kuwai, Takashi Okuyama, Akihiro Ohuchi, Shinobu Ohnuma, Kazuhiro Sakamoto, Tamotsu Sugai, Kenji Katsumata, Hiro-O Matsushita, Keisuke Nakai, Toshio Uraoka, Naohiko Akimoto, Hirotoshi Kobayashi, Yoichi Ajioka, Kenichi Sugihara, Hideki Ueno,
来源：
ANNALS OF SURGERY
摘要：
为探讨在高危T1结直肠癌（CRC）局部切除（LE）后是否省略额外手术对患者预后的影响。对2009年至2016年间在日本结直肠癌学会（JSCCR）机构接受T1 CRC局部切除的患者进行分析。使用倾向得分匹配（PS匹配）方法，将接受额外手术和不接受额外手术的患者进行1：1的配对。从27个JSCCR机构的1,975名患者中获得401个PS匹配对进行比较。LE+手术组中有31名（7.7%）患者出现区域淋巴结转移。相比之下，在LE单独组中，肿瘤学不良事件的发生率较低，如5年局部复发的累积风险（4.1%）或总复发（5.5%）。此外，LE+手术组和LE单独组之间的5年CSS差距仅为1.8%（分别为99.7%和97.9%），而LE单独组的5年OS明显低于LE+手术组（分别为88.5%和94.5%，P=0.002）。在专门的CRC治疗中心决定省略额外手术的患者出现了少量肿瘤学事件和令人满意的CSS，这可能表明风险评估在非肿瘤学不良事件方面对于实现每个高危T1肿瘤患者的最佳实践具有重要作用。版权所有© 2023 Wolters Kluwer Health, Inc. 保留所有权利。
To investigate how omitting additional surgery after local excision (LE) affects patient outcomes in high-risk T1 colorectal cancer (CRC).It is debatable whether additional surgery should be performed for all patients with high-risk T1 CRC regardless of the tolerability of invasive procedures.Patients who had received LE for T1 CRC at the Japanese Society for Cancer of the Colon and Rectum (JSCCR) institutions between 2009 and 2016 were analyzed. Those who had received additional surgical resection and who did not were matched one-on-one by the propensity score (PS)-matching method. A total of 401 PS-matched pairs were extracted from 1,975 patients at 27 JSCCR institutions and compared.Regional lymph node metastasis was observed in 31 (7.7%) patients in the LE+surgery group. Comparatively, the incidence of oncologic adverse events was low in the LE-alone group, such as the 5-year cumulative risk of local recurrence (4.1%) or overall recurrence (5.5%). In addition, the difference in the 5-year CSS between the LE+surgery and LE-alone groups was only 1.8% (99.7% and 97.9%, respectively), whereas the 5-year OS was significantly lower in the LE-alone group than in the LE+surgery group (88.5% vs. 94.5%, respectively (P=0.002).Those who had been decided to omit additional surgery at the dedicated center for CRC treatment presented a small number of oncologic events and a satisfactory CSS, which may suggest an important role of risk assessment regarding non-oncologic adverse events to achieve a best practice for each individual with high-risk T1 tumors.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.