How Does Omitting Additional Surgery After Local Excision Affect the Prognostic Outcome of Patients With High-risk T1 Colorectal Cancer?
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Ouchi Akira, Komori Koji, Masahiro Tajika, Toriyama Kazuhiro, Kajiwara Yoshiki, Oka Shiro, Fukunaga Yosuke, Hotta Kinichi, Ikematsu Hiroaki, Tsukamoto Shunsuke, Nagata Shinji, Yamada Kazutaka, Konno Maki, Ishihara Soichiro, Saitoh Yusuke, Matsuda Kenji, Togashi Kazutomo, Ishiguro Megumi, Kuwai Toshio, Okuyama Takashi, Ohuchi Akihiro, Ohnuma Shinobu, Sakamoto Kazuhiro, Sugai Tamotsu, Katsumata Kenji, Matsushita Hiro-O, Nakai Keisuke, Uraoka Toshio, Akimoto Naohiko, Kobayashi Hirotoshi, Ajioka Yoichi, Sugihara Kenichi, Ueno Hideki, Study Group for the JSCCR-T study
Аннотация
BACKGROUND: It is debatable whether additional surgery should be performed for all patients with high-risk T1 CRC regardless of the tolerability of invasive procedures.
METHODS: Patients who had received LE for T1 CRC at the Japanese Society for Cancer of the Colon and Rectum institutions between 2009 and 2016 were analyzed. Those who had received additional surgical resection and those who did not were matched one-on-one by the propensity score-matching method. A total of 401 propensity score-matched pairs were extracted from 1975 patients at 27 Japanese Society for Cancer of the Colon and Rectum institutions and were compared.
RESULTS: 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 cancer-specific survival between the LE + surgery and LE-alone groups was only 1.8% (99.7% and 97.9%, respectively), whereas the 5-year overall survival was significantly lower in the LE-alone group than in the LE + surgery group [88.5% vs 94.5%, respectively ( P = 0.002)].
CONCLUSIONS: Those who had decided to omit additional surgery at the dedicated center for CRC treatment presented a small number of oncologic events and a satisfactory cancer-specific survival, which may suggest an important role of risk assessment regarding nononcologic adverse events to achieve a best practice for each individual with high-risk T1 tumors.