Recurrence and cancer-specific mortality after endoscopic resection of low- and high-risk pT1 colorectal cancers: a meta-analysis

Antonelli, Giulio; Vanella, Giuseppe; Orlando, Davide; Angeletti, Stefano; Giulio, Emilio Di

doi:10.1016/j.gie.2019.05.045

Cited by 18 publications

(18 citation statements)

References 29 publications

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“…Of the 117 patients in the NC-ER group, RFS was significantly lower in the ASR subgroup than in surveillance-only subgroup. Similar to our results, recurrence after ER of T1 CRC patients was 9.5% in high-risk lesions (poor differentiation, SID > 1000 µm, LVI and positive resection margin), which was higher than that in patients with low risk lesions (1.2%) in a recent meta-analysis [20]. This suggests that ASR should be warranted in the T1 CRC patients undergoing NC-ER for the aspect of recurrence.…”

Section: Discussionsupporting

confidence: 89%

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Park

Baek

Lee

et al. 2020

JCM

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Background and Aims: Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). Little is known about the long-term outcomes of patients in these two groups. Therefore, we have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. Methods: We conducted a retrospective study on 220 patients with T1 CRC treated with ER from January 2007 to December 2017. First, we investigated the long-term outcomes (5-year overall survival [OS] and recurrence-free survival [RFS]) in the C-ER group (n = 49). In the NC-ER group (n = 171), we compared long-term outcomes between patients who underwent additional surgical resection (ASR) (n = 117) and those who did not (surveillance-only, n = 54). Results: T1 CRC patients in the C-ER and NC-ER groups had a median follow-up of 44 (interquartile range 32–69) months. There was no risk of tumor recurrence and cancer-related deaths in patients with C-ER. In the NC-ER group, the 5-year OS rates were 75.3% and 92.6% in the surveillance-only and ASR subgroups, respectively. The hazard ratio (HR) for ASR in NC-ER vs. surveillance-only in NC-ER was statistically insignificant. However, RFS rates were significantly different between the ASR (97.2%) and surveillance-only (84.0%) subgroups. Multivariate analysis indicated a submucosal invasion depth (SID) of >2500 µm and margin positivity to be associated with recurrence. Conclusions: The surveillance-only approach can be considered as an alternative surgical option for T1 CRCs in selected patients undergoing NC-ER.

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Section: Discussionsupporting

confidence: 89%

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Park

Baek

Lee

et al. 2020

JCM

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“…A recent review 92 of local recurrence rates for pT1 colorectal tumours excised endoscopically without additional treatment identified an overall recurrence rate of 9 per cent for rectal cancer. The present data showed that high‐risk pT1 is associated with a relatively high risk of recurrence of 13·6 per cent after local excision alone, which is consistent with previous findings 46,53 .…”

Section: Discussionmentioning

confidence: 99%

Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

Oostendorp

Smits

Vroom

et al. 2020

British Journal of Surgery

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Background: The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to determine oncological outcomes after local excision of pT1-2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT). Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions. Results: Some 73 studies comprising 4674 patients were included in the analysis. Sixty-two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low-risk pT1 tumours was 6⋅7 (95 per cent c.i. 4⋅8 to 9⋅3) per cent. There were no local recurrences of low-risk pT1 tumours after cTME or aCRT. The local recurrence rate for high-risk pT1 tumours was 13⋅6 (8⋅0 to 22⋅0) per cent for local excision only, 4⋅1 (1⋅7 to 9⋅4) per cent for cTME and 3⋅9 (2⋅0 to 7⋅5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28⋅9 (22⋅3 to 36⋅4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14⋅7 (11⋅2 to 19⋅0) per cent after aCRT. Conclusion: There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high-risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high-risk pT1 tumours, but shows a higher risk for pT2 tumours.

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“…As a result, several studies did not receive maximum scores on certain risk of bias items, and a considerable number of studies and patients could not be included in the different subgroup analyses. A previous meta-analysis 94 tried to circumvent these issues by using stricter study selection criteria: they only included studies written in English with more than 12 months of follow-up, using at least 4 JSCCR criteria and with the possibility to separate the outcomes according to the histologic risk category. We chose not to adopt such a strategy because the use of too many selection criteria could result in the exclusion of important studies.…”

Section: Paɵent-centered Shared Decision Makingmentioning

confidence: 99%

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

Dekkers

Cessie

Hooft

et al. 2022

Clinical Gastroenterology and Hepatology

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High-risk: 7.0% Low-risk: 0.7% BACKGROUND & AIMS:Growing numbers of patients with T1 CRC are being treated with local endoscopic resection only and as a result, the need for optimization of surveillance strategies for these patients also increases. We aimed to estimate the cumulative incidence and time pattern of CRC recurrences for endoscopically treated patients with T1 CRC. METHODS:Using a systematic literature search in PubMed, EMBASE, Web of Science and Cochrane Library (from inception till 15 May 2020), we identified and extracted data from studies describing the cumulative incidence of local or distant CRC recurrence for patients with T1 CRC treated with local endoscopic resection only. Pooled estimates were calculated using mixed-effect logistic regression models. RESULTS:Seventy-one studies with 5167 unique, endoscopically treated patients with T1 CRC were included. The pooled cumulative incidence of any CRC recurrence was 3.3% (209 events; 95% CI, 2.6%-4.3%; I 2 [ 54.9%), with local and distant recurrences being found at comparable rates (pooled incidences 1.9% and 1.6%, respectively). CRC-related mortality was observed in 42 out of 2519 patients (35 studies; pooled incidence 1.7%, 95% CI, 1.2%-2.2%; I 2 [ 0%), and the CRC-related mortality rate among patients with recurrence was 40.8% (42/103 patients). The vast majority of recurrences (95.6%) occurred within 72 months of follow-up. Pooled incidences of any CRC recurrence were 7.0% for high-risk T1 CRCs (28 studies; 95% CI, 4.9%-9.9%; I 2 [ 48.1%) and 0.7% (36 studies; 95% CI, 0.4%-1.2%; I 2 [ 0%) for low-risk T1 CRCs. CONCLUSIONS:Our meta-analysis provides quantitative outcome measures which are relevant to guidelines on surveillance after local endoscopic resection of T1 CRC.

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Recurrence and cancer-specific mortality after endoscopic resection of low- and high-risk pT1 colorectal cancers: a meta-analysis

Cited by 18 publications

References 29 publications

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment

Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis

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