Subpopulation analysis of survival in high-risk T1 colorectal cancer: surgery versus endoscopic resection only

医学 危险系数 切除缘 结直肠癌 置信区间 比例危险模型 外科 内科学 癌症 肿瘤科 胃肠病学 切除术
作者
Ryun Ha,Boram Park,Kyung Su Han,Dae Kyung Sohn,Chang Won Hong,Byung Chang Kim,Bun Kim,Sung Chan Park,Hee Jin Chang,Jae Hwan Oh
出处
期刊:Gastrointestinal Endoscopy [Elsevier BV]
卷期号:96 (6): 1036-1046.e1 被引量:5
标识
DOI:10.1016/j.gie.2022.07.016
摘要

This study aimed to assess the long-term survival of patients with T1 colorectal cancer (CRC) after local or surgical resection considering the type and number of risk factors for lymph node metastasis.This study included patients with high-risk T1 CRC who underwent therapeutic resection at the National Cancer Center, Korea between January 2001 and December 2014. Risk factors included positive resection margin, high-grade histology, deep submucosal invasion, vascular invasion, budding, and no background adenoma (BGA). We statistically divided the population into favorable or unfavorable subpopulations. The favorable subpopulation included the following 5 combinations of risk factors: positive margin only or unconditional for margin status, deep submucosal invasion only, budding only, no BGA only, and budding + no BGA. We analyzed the survival rate according to the resection type (local or surgical) in the total cohort and in each subpopulation.Eighty-one and 466 patients underwent local and surgical resections, respectively. The distant recurrence-free survival (DRFS) and overall survival (OS) rates were significantly high in the surgical group (hazard ratio [HR], .20; 95% confidence interval [CI], .06-.61; P = .0045 and HR, .41; 95% CI, .25-.70; P = .0010, respectively). In the favorable subpopulation, both DRFS and OS rates were not significantly different between the surgical and local groups (HR, .26; 95% CI, .02-4.19; P = .3431 and HR, .58; 95% CI, .27-1.23; P = .1534, respectively).Intensive surveillance without additional surgery may be another option in selected cases after of high-risk T1 CRC endoscopic resection.
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