医学
危险系数
结直肠癌
置信区间
结肠镜检查
内镜黏膜下剥离术
前瞻性队列研究
内科学
外科
粘膜切除术
队列
胃肠病学
比例危险模型
多中心试验
多中心研究
癌症
内窥镜检查
随机对照试验
作者
Ken Ohata,Nozomu Kobayashi,Eiji Shimizu,Yoji Takeuchi,Akiko Chino,Hiroyuki Takamaru,Shinya Kodashima,Kinichi Hotta,Kensuke Harada,Hiroaki Ikematsu,Toshio Uraoka,Takashi Murakami,Shigetsugu Tsuji,Takashi Abe,Atsushi Katagiri,Shinichiro Hori,Tomoki Michida,Takuto Suzuki,Masakatsu Fukuzawa,Shinsuke Kiriyama,Kazutoshi Fukase,Yoshitaka Murakami,Hideki Ishikawa,Yutaka Saito
出处
期刊:Gastroenterology
[Elsevier]
日期:2022-11-01
卷期号:163 (5): 1423-1434.e2
被引量:15
标识
DOI:10.1053/j.gastro.2022.07.002
摘要
To determine the long-term outcomes after colorectal endoscopic submucosal dissection (ESD), we conducted a large, multicenter, prospective cohort trial with a 5-year observation period.Between February 2013 and January 2015, we consecutively enrolled 1740 patients with 1814 colorectal epithelial neoplasms ≥20 mm who underwent ESD. Patients with noncurative resection (non-CR) lesions underwent additional radical surgery, as needed. After the initial treatment, intensive 5-year follow-up with planned multiple colonoscopies was conducted to identify metastatic and/or local recurrences. Primary outcomes were overall survival, disease-specific survival, and intestinal preservation rates. The rates of local recurrence and metachronous invasive cancer were evaluated as the secondary outcomes.The 5-year overall survival, disease-specific survival, and intestinal preservation rates were 93.6%, 99.6%, and 88.6%, respectively. Patients with CR lesions had no metastatic occurrence, and patients with non-CR lesions had 4 metastatic occurrences. Kaplan-Meier curves revealed that overall survival and disease-specific survival rates were significantly higher in patients with CR lesions than in those with non-CR lesions (P > .001 and P = .009, respectively). Local recurrence occurred in only 8 lesions (0.5%), which were successfully resected by subsequent endoscopic treatment. Multiple logistic regression analyses revealed that piecemeal resection (hazard ratio, 8.19; 95% CI, 1.47-45.7; P = .02) and margin-positive resection (hazard ratio, 8.06; 95% CI, 1.76-37.0; P = .007) were significant independent predictors of local recurrence after colorectal ESD. Fifteen metachronous invasive cancers (1.0%) were identified during surveillance colonoscopy, most of which required surgical resection.A favorable long-term prognosis indicates that ESD can be the standard treatment for large colorectal epithelial neoplasms.UMIN000010136.