早期结直肠癌内镜黏膜下剥离术后伴有高危因素患者的等待观察策略可行性

Feasibility of wait and watch strategy for patients with high-risk factors after endoscopic submucosal dissection for early colorectal cancer

目的探讨对结直肠早期癌行内镜黏膜下剥离术(ESD)术后病理存在高危因素患者行等待观察治疗策略的可行性。方法选取2012年12月—2020年6月首都医科大学附属北京友谊医院普通外科收治ESD术后存在病理高危因素的结直肠癌早期癌患者104例, 其中男性62例, 女性42例, 年龄31~89岁, 平均(59.5±10.8)岁。依后续治疗方式分为接受追加手术组和等待观察组;比较两组ESD术后病理高危因素类型差异。呈正态分布的计量资料以均数±标准差(Mean±SD)表示, 组间比较采用t检验, 计数资料组间比较采用χ2检验。采用Log-Rank检验比较两组的总生存期和无疾病进展生存期(PFS)。结果追加手术组43例, 等待观察组61例, 中位随访时间(40.6±15.3)个月。追加手术组与等待观察组总生存期和PFS分别为100.0%比98.4%、90.7%比90.2%, 两组间差异无统计学意义(OS:χ^(2)=0.875, P=0.35;PFS:χ^(2)=0.017, P=0.80)。结论等待观察策略有望作为部分结直肠早期癌ESD术后存在高危因素患者的后续选择之一。

Objective:To explore the feasibility of wait and watch treatment for patients with high-risk pathology factors after endoscopic submucosal dissection(ESD)for early colorectal cancer.Methods:From December 2012 to June 2020,104 patients,including 62 males and 42 females,aged from 31 to 89 years old,with the average of(59.5±10.8)years with early colorectal cancer after ESD operation were selected from the Department of General Surgery,Beijing Friendship Hospital,Capital Medical University.According to the follow-up treatment,the patients were divided into two groups:the additional surgical resection group and the wait and watch group.The measurement data of normal distribution were shown by mean standard deviation,the comparison between groups adopted t test,and the comparison of counting data between groups adopted χ^(2) test.The types of pathological high-risk factors after ESD were compared between the two groups,and the overall survival(OS)and progression free survival(PFS)of the two groups were compared by Log-Rank test.Results:The median follow-up time was(40.6±15.3)months.The OS and PFS of the additional surgical resection group and the wait and watch group were 100.0%vs 98.4%and 90.7%vs 90.2%,respectively,and there was no statistically significant difference between the two groups(OS:χ^(2)=0.875,P=0.35;PFS:χ^(2)=0.017,P=0.80).Conclusion:The wait and watch strategy is expected to be one of the follow-up choices for some patients with high risk factors after ESD operation for early colorectal cancer.