■为了阐明阻塞性结直肠癌(CRC)的自膨式金属支架(SEMS)放置是否会增加神经周浸润(PNI),从而使预后恶化。
■总共,回顾性分析1022例病理为T3或T4的结肠或直肠乙状结肠癌切除患者。将研究患者分为无梗阻组(n=693),阻塞无支架组(n=251),支架组(n=78),以及证明与PNI有独立关联的因素,组间PNI发生率和严重程度的差异,研究了PNI与从SEMS置入到手术持续时间之间的相关性.对每组进行生存分析。
■关于多变量分析,SEMS放置(危险比[HR]:2.08)与PNI独立相关,而SEMS放置则与PNI无关。PNI发生在39%,45%,68%的没有阻塞,无支架阻塞,和支架组阻塞,分别。在有支架的阻塞组中,PNI的比例与从SEMS置入到手术的持续时间无关.壁外PNI,PNI的高级形式,显示没有随着间隔的增加而增加。五年OS为86.3%,76.7%,73.1%无梗阻,无支架阻塞,和支架组阻塞,分别。在多变量分析中,梗阻是OS降低的独立危险因素(HR:1.57),而SEMS置入不是.
■SEMS置入患者与未接受SEMS置入的梗阻患者的预后相当,从而证明SEMS是可行的,BTS的治疗选择。
UNASSIGNED: To clarify whether self-expandable metallic stent (SEMS) placement for obstructive colorectal cancer (CRC) increases perineural invasion (PNI), thereby worsening the prognosis.
UNASSIGNED: In total, 1022 patients with pathological T3 or T4 colon or rectosigmoid cancer who underwent resection were retrospectively reviewed. The study patients were divided into a no obstruction group (n=693), obstruction without stent group (n=251), and obstruction with stent group (n=78), and factors demonstrating an independent association with PNI, the difference in PNI incidence and severity between groups, and the association between PNI and the duration from SEMS placement to surgery were investigated. Survival analysis was performed for each group.
UNASSIGNED: On multivariate analysis, SEMS placement (hazard ratio [HR]: 2.08) was independently associated with PNI whereas SEMS placement was not. PNI occurred in 39%, 45%, and 68% of the no obstruction, obstruction without stent, and obstruction with stent group, respectively. In the obstruction with stent group, the proportion of PNI was not associated with the duration from SEMS placement to surgery. Extramural PNI, an advanced form of PNI, demonstrated no increase with increasing interval. The five-year OS was 86.3%, 76.7%, and 73.1% in no obstruction, obstruction without stent, and obstruction with stent group, respectively. On multivariate analysis, obstruction was an independent risk factor of decreased OS (HR: 1.57) whereas SEMS placement was not.
UNASSIGNED: The prognosis was comparable between patients with SEMS placement and those with an obstruction who did not undergo SEMS placement, thus demonstrating that SEMS is a viable, therapeutic option for BTS.