Long-term outcomes after treatment for T1 colorectal carcinoma

Asayama, Naoki; Oka, Shiro; Tanaka, Shinji; Ninomiya, Yuki; Tamaru, Yuzuru; Shigita, Kenjiro; Hayashi, Nana; Egi, Hiroyuki; Hinoi, Takao; Ohdan, Hideki; Arihiro, Koji; Chayama, Kazuaki

doi:10.1007/s00384-015-2473-6

Cited by 45 publications

(37 citation statements)

References 33 publications

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“…Succeeding studies have reported high recurrence rates and significantly lower survival rates for early colorectal cancer accompanied by risk factors of lymph node metastasis that was treated endoscopically only. [233][234][235] Thus, although endoscopic resection effectively treats mucosal colorectal cancer and submucosal colorectal cancer without the risk factors of lymph node metastasis, additional surgery should be considered for submucosal colorectal cancer with the risk factors of lymph node metastasis.…”

Section: Early Colorectal Cancermentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Early Colorectal Cancermentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…Data from the published literature on patients with T1 CRC at the mean age of 65 years were used as inputs for the model. 7,[17][18][19][20][21][22][23][24][25][26][27][28] Hospital and treatment costs reflected Medicare reimbursement rates.…”

Section: Parameter Estimatesmentioning

confidence: 99%

Cost-effectiveness Evaluation of Targeted Surgical and Endoscopic Therapies for Early Colorectal Adenocarcinoma Based on Biomarker Profiles

Jang

Truong

et al. 2020

JAMA Netw Open

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IMPORTANCEColorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States. The prognosis for patients with CRC varies widely, but new prognostic biomarkers provide the opportunity to implement a more individualized approach to treatment selection. OBJECTIVE To assess the cost-effectiveness of 3 therapeutic strategies, namely, endoscopic therapy (ET), laparoscopic colectomy (LC), and open colectomy (OC), for patients with T1 CRC with biomarker profiles that prognosticate varying levels of tumor progression in the US payer perspective. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation study, a Markov model was developed for the cost-effectiveness analysis. Risks of all-cause mortality and recurrent cancer after ET, LC, or OC were estimated with a 35-year time horizon. Quality of life was based on EuroQoL 5 Dimensions scores reported in the published literature. Hospital and treatment costs reflected Medicare reimbursement rates. Deterministic and probabilistic sensitivity analyses were performed. Data from patients with T1 CRC and 6 biomarker profiles that included adenomatous polyposis coli (APC), TP53 and/or KRAS, or BRAFV600E were used as inputs for the model. Data analyses were conducted from February 27, 2019, to May 13, 2019. EXPOSURES Endoscopic therapy, LC, and OC. MAIN OUTCOMES AND MEASURES The primary outcomes were unadjusted life-years, qualityadjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) between competing treatment strategies. RESULTS Endoscopic therapy had the highest QALYs and the lowest cost and was the dominant treatment strategy for T1 CRC with the following biomarker profiles: BRAFV600E, APC(1)/KRAS/TP53, APC(2) or APC(2)/KRAS or APC(2)/TP53, or APC(1) or APC(1)/KRAS or APC(1)/TP53. The QALYs gained

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“…Previous studies examining the clinical course after the treatment of early colorectal cancer reported recurrence rates of 0%-2.3% after endoscopic resection for low-risk T1 cancers, 4.4%-20% after endoscopic resection for high-risk T1 cancer, and 1.4%-5.6% after surgical resection for high-risk T1 cancer. 12,[21][22][23][24][25][26] In our study, which investigated the patients who underwent endoscopic resection at first with the estimation of SSMC the overall recurrence rate was 1.2%. The recurrence rate was 0.8% in the low-risk group (1/125), and 1.2% in the high-risk group with additional surgery, similar with that of the previous studies.…”

Section: Discussionmentioning

confidence: 84%

“…Additional surgery is therefore recommended. 12,13,[21][22][23][24][25][26][27] However, residual cancer or regional lymph node metastasis is not always found in surgical specimens after additional surgery. In our study, residual cancer and/or regional lymph node metastasis were found only in 47 (14.0%) of 336 surgically performed cases due to high-risk pathological features.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery

et al. 2020

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cancer by routine screening tests and to then treat them to block further development into advanced colorectal cancer. Thus, clinical practice guidelines suggest various screening tests including colonoscopy. 3-5 Colonoscopy is especially useful due to its ability to detect and treat precancerous polyp and early colorectal cancer. 6 Of early colorectal cancers, superficial submucosal colorectal cancer (SSMC) defined by the depth of invasion from muscularis mucosa as less than 1,000 μm, can be completely cured by endoscopic resection if it does not have any adverse pathologic findings including poorly differentiated adenocar

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Long-term outcomes after treatment for T1 colorectal carcinoma

Abstract: Long-term outcomes support the curative criteria according to the JSCCR guidelines. ER for T1 CRC did not worsen clinical outcomes in cases that required additional surgical resection.

Cited by 45 publications

References 33 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Cost-effectiveness Evaluation of Targeted Surgical and Endoscopic Therapies for Early Colorectal Adenocarcinoma Based on Biomarker Profiles

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery

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