追加外科手术治疗对高风险T1期结直肠癌内镜切除患者的预后影响  

Prognosis Analysis of Additional Surgical Treatment for High-Risk T1 Colorectal Cancer Patients After Endoscopic Resection

作　　者：罗鑫悦 陈宇翔 杨锦林[1] 邓凯 吴俊超[1] 甘涛[1] LUO Xinyue;CHEN Yuxiang;YANG Jinlin;DENG Kai;WU Junchao;GAN Tao(Department of Gastroenterology&Hepatology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院消化内科,成都610041

出　　处：《四川大学学报（医学版）》2024年第2期411-417,共7页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金项目(No.82173253)资助。

摘　　要：目的 分析内镜下切除后追加外科手术对于高风险T1期结直肠癌患者生存预后的影响。方法 回顾性收集高风险T1期结直肠癌患者,根据内镜下切除后是否追加外科手术分为追加外科手术(endoscopic resection+surgical resection, ER+SR)组和内镜切除(endoscopic resection, ER)组,收集患者基线信息及病变部位、大小、术后病理等资料,并通过病历系统及随访等获得患者生存相关信息,主要结局指标为总生存率以及结直肠癌特异性生存率。采用单因素Cox回归分析分析筛选生存相关风险因素,计算风险比(HR),并通过多因素Cox回归分析独立影响因素。结果 共收集109例高风险T1期结直肠癌患者,其中ER组52例,ER+SR组57例,ER组的患者平均年龄高于ER+SR组(65.21岁vs. 60.54岁,P=0.035),ER组内镜下病变长径中位数略小于ER+SR组(2.00 cm vs. 2.50 cm,P=0.026)。ER+SR组中位随访时间为30.00个月,最长随访119.00个月,共有4名患者死亡,1名为结直肠癌相关死亡;而ER组中位随访时间为28.50个月,最长随访78.00个月,共有4名患者死亡,1名死于结直肠癌。5年累积生存率比较中,ER+SR组及ER组总生存率分别为94.44%和81.65%,而5年累积肿瘤特异性生存率分别为97.18%和98.06%。Kaplan-Meier分析显示ER+SR组及ER组患者累积总生存率、累积肿瘤特异性生存率差异无统计学意义。Cox单因素回归分析显示年龄及复查次数为总生存率相关危险因素(HR=1.16及0.27,P=0.005及0.025),进一步多因素Cox回归分析显示年龄为总生存率相关独立危险因素(HR=1.10,P=0.045)。结论 对于内镜切除术后存在高风险因素的T1期结直肠癌患者,也不可忽视患者年龄、自身意愿等因素,在实际临床实践过程中更加慎重地选择追加外科手术。Objective To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.Methods The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected.The patients were divided into the endoscopic resection(ER)plus additional surgical resection(SR)group,or the ER+SR group,and the ER group according to whether additional SR were performed after ER.Baseline data of the patients and information on the location,size,and postoperative pathology of the lesions were collected.Patient survival-related information was obtained through the medical record system and patient follow-up.The primary outcome indicators were the overall survival and the colorectal cancer-specific survival.Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio(HR)was calculated.Multivariate Cox regression analysis was used to analyze the independent influencing factors.Results The data of 109 patients with T1 high-risk colorectal cancer were collected,with 52 patients in the ER group and 57 patients in the ER+SR group.The mean age of patients in the ER group was higher than that in the ER+SR group(65.21 years old vs.60.54 years old,P=0.035),and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group(2.00 cm vs.2.50 cm,P=0.026).The median follow-up time was 30.00 months,with the maximum follow-up time being 119 months,in the ER+SR group and there were 4 patients deaths,including one colorectal cancer-related death.Whereas the median follow-up time in the ER group was 28.50 months,with the maximum follow-up time being 78.00 months,and there were 4 patient deaths,including one caused by colorectal cancer.The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44%and 81.65%,respectively,and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18%an

关 键 词：T1期结直肠癌 高风险 内镜切除 外科手术 生存预后 

分 类 号：R735.34[医药卫生—肿瘤]