早期结直肠癌内镜下治疗的远期疗效分析

Long-term outcome after endoscopic resection for early colorectal carcinoma

目的:探讨内镜下治疗早期结直肠癌的远期疗效。方法:回顾性分析2008年6月至2016年6月于中国医学科学院肿瘤医院内镜科行内镜下治疗的550例早期结直肠癌患者的临床和随访资料,分析内镜下治疗早期结直肠癌的远期无复发生存率,并探讨黏膜下层浸润深度、低分化腺癌、脉管侵犯、垂直切缘阳性等危险因素对远期预后的影响。结果:550例内镜下治疗患者的随访时间为(60.7±36.8)个月,黏膜高级别瘤变433例,黏膜下层浸润癌117例(其中浸润深度<1000μm 33例,浸润深度≥1000μm 84例);治愈性切除461例,非治愈性切除89例。随访过程中,6例患者发生复发转移,其中2例局部复发(1例同时伴有淋巴结转移),4例发生淋巴结转移(2例同时伴发远处转移)。550例患者的5年无复发生存率为98.8%,其中治愈性切除患者的5年无复发生存率为100.0%,非治愈性切除患者的5年无复发生存率为93.3%。89例非治愈性切除患者合并肿瘤浸润深度≥1000μm、脉管侵犯、低分化腺癌和垂直切缘阳性,其中有1种危险因素者62例,有2种危险因素者23例,有3种危险因素者4例。随着危险因素的增多,淋巴结和远处转移的风险随之增加。结论:早期结直肠癌的淋巴结转移率很低,经内镜下治疗可获得较好的远期疗效,内镜下治疗术后应密切随访,同时术后应根据患者的不良预后危险因素合理选择后续追加治疗方案,以保证患者长期生存的同时提高患者的生活质量。

Objective To analysis the clinical and follow-up data of the early colorectal carcinoma(ECC)after endoscopic resection,and explore the long-term outcome of patients who underwent the endoscopic resection.Methods During June 2008 to June 2016,data of endoscopic resection for 550 cases of ECC were collected,including general information and follow-up data.The influence factors of disease-free survival rate of ECC after endoscopic resection were analyzed and the risk factors on long-term outcomes such as submucosa invasion depth,poorly differentiated adenocarcinoma,vascular invasion and positive vertical margin were investigated.Results The mean follow-up time of 550 patients treated with endoscopy was(60.7±36.8)months.Among them,433 cases were high-level intra-mucosal neoplasia,117 cases were submucosa invasion carcinoma(the invasion depth<1000μm were 33 cases,≥1000μm were 84 cases),461 cases were curative resection,while 89 cases were non-curative resection.During the follow-up,6 patients occurred recurrence or metastasis,including 2 patients with local recurrence(1 patient accompanied by lymph node metastasis)and 4 patients with lymph node metastasis(2 patients accompanied by distant metastasis).The overall 5-years disease-free survival rate was 98.8%,the 5-years disease-free survival rate was 100.0%for patients with curative resection and 93.3%for patients with non-curative resection.A total of 89 cases underwent non-curative resection were accompanied with invasion depth≥1000μm,vascular invasion,poorly differentiated adenocarcinoma and positive vertical margin.Among them,62 cases were accompanied with 1 risk factor,23 cases with 2 risk factors and 4 cases with 3 risk factors.The risks of lymph nodes and distant metastasis raised with the increase of risk factors.Conclusions The incidence of lymph node metastasis in ECC is extremely low.Endoscopic treatment can achieve a good long-term outcome.Close follow-up should be conducted after endoscopic treatment,and additional treatment should be selected reasonably for the early colorectal carcinoma after endoscopic non-curative resection to improve the therapeutic efficacy of endoscopic resection.