The Role of Tumor Location on Endoscopic and Surgical Management of Malignant Colon Polyps.

Autor: Weaver L; Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Boatman S; Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Kohn J; Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Mott SL; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA., Gaertner WB; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.; Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Madoff RD; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.; Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Melton GB; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.; Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Shaukat A; Department of Gastroenterology, New York University Langone Health, New York, NY, USA., Hassan I; Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA., Goffredo P; Department of Surgery, University of Minnesota, Minneapolis, MN, USA. goffr002@umn.edu.; Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. goffr002@umn.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Oct; Vol. 31 (10), pp. 6452-6460. Date of Electronic Publication: 2024 Jul 30.
DOI: 10.1245/s10434-024-15931-4
Abstrakt: Background: Endoscopic polypectomy could be an appropriate, definitive treatment for pathologic T1 (pT1) colon polyps without high-risk features. Prior studies suggested worse prognosis for proximal versus distal advanced-stage colon cancers following curative treatment. However, there is limited evidence on the prognostic impact of tumor location for pT1s.
Patients and Methods: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results database to identify adults with T1NxMx or T1N0-3M0/x colon adenocarcinoma from 2000 to 2019.
Results: A total of 3398 patients underwent endoscopic polypectomy (17% proximal) and 28,334 had a partial colectomy (49% proximal) for pT1 adenocarcinoma. Following endoscopic polypectomy, 5-year overall and cancer-specific survival rates were 64% and 91% for proximal versus 83% and 96% for distal polyps, compared with 82% and 95% for proximal versus 88% and 97% for distal tumors after colectomy. In multivariable models, there was a greater difference in overall survival between proximal and distal polyps for those who underwent endoscopic versus surgical resection [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.49-2.02 vs. HR 1.13, 95% CI 1.08-1.18]. Patients with proximal versus distal polyps who underwent polypectomy also exhibited increased cancer-specific mortality (HR 1.94, 95% CI 1.37-2.75). However, cancer-specific survival variations based on tumor location were no longer observed in patients undergoing partial colectomy (HR 1.09, 95% CI 0.98-1.21).
Conclusions: Proximal tumor location was independently associated with worse overall and cancer-specific survival following endoscopic polypectomy. However, after colectomy, the cancer-specific disparity based on tumor laterality was mitigated. These findings suggest that proximal location may be considered a high-risk feature in endoscopic polypectomy.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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