Long-term outcomes of different treatment strategies in T1 colorectal cancer patients

Aims The treatment strategies of T1 colorectal cancer (CRC) remains controversial. We aimed to investigate the long-term outcomes of the different treatments, and evaluated the risk factors for the prognosis.

Methods We enrolled patients with pT1 CRC between February 2010 and May 2023. The patients were divided into 4 groups based on their treatment, Group A, endoscopic resection; Group B, endoscopic or surgical local resection with additional radical resection; Group C, surgical local resection; Group D, radical resection. Their medical histories were retrospectively reviewed, and follow-up results was obtained by medical histories or telephone calls.

Results 1256 patients were finally chosen for analysis. The number of patients was 182, 280, 123, and 671 in each group, respectively. With a median follow-up of 40 months, 60 patients had recurrence (4.8%). The 5-year DFS rates in each group were 83.7%, 92.0%, 73.5%, and 90.2%, respectively (P<0.001). The 5-year overall survival (OS) rates survival rates in each group were 89.5%, 94.8%, 84.8%, and 95.0% (P=0.059). The differences in DFS after different treatments mainly lied in the patients with risk factors based on the European Society of Gastrointestinal Endoscopy (ESGE) and Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines. Multivariate analyses identified age≥65 (HR 2.91; 95% CI 1.96-4.30), unfavorable histologic grade (HR 2.52; 95%CI 1.41-4.52), rectal cancer (HR 1.91; 95% CI 1.24-2.94), and lymphovascular invasion (HR 2.58; 95% CI 1.41-4.73) as independent predictive factors of DFS, and age≥65 (HR 7.96; 95% CI 4.36-14.53), rectal cancer (HR 1.90; 95% CI 1.07-3.38), and lymphovascular invasion (HR 2.42; 95% CI 1.04-3.65) as independent predictive factors of OS.

Conclusions The long-term outcomes of local resection are comparable to those of surgery in patients without high-risk factors, while for those with high-risk factors surgical local resection showed poorer RFS when compared with other groups. Age, tumor histologic grade, rectal cancer, and lymphovascular invasion may be important long-term prognostic factors for pT1 CRC patients.

Publication History

Article published online:
27 March 2025