Prognostic factors and long-term outcomes with endoscopic submucosal dissection for colorectal tumors in patients aged 75 years or older

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

DEN open Pub Date : 2025-05-06 DOI:10.1002/deo2.70137

Takaya Miura, Satohiro Matsumoto, Azumi Sato, Shu Kojima, Goya Sasaki, Mina Morino, Keita Matsumoto, Hitomi Kashima, Yudai Koito, Takehiro Ishii, Shuhei Yoshikawa, Haruka Otake, Takeshi Uehara, Masanari Sekine, Takeharu Asano, Hiroyuki Miyatani, Hirosato Mashima

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Abstract

Background

Studies regarding the long-term outcomes of endoscopic submucosal dissection (ESD) performed in older patients with colorectal tumors are limited. Therefore, in this study, we aimed to analyze the long-term outcomes of older patients with colorectal tumors who underwent ESD and identify prognostic factors.

Methods

The data of patients aged ≥ 75 years who underwent ESD for colorectal tumors (adenoma and Tis/T1 colorectal cancer) at a single center were retrospectively analyzed. Prognostic factors for overall survival were analyzed using the Kaplan–Meier method and the Cox proportional hazard model.

Results

Of the 156 patients included, 51 patients died during the follow-up period, among whom two deaths were due to colorectal cancer. The univariate analysis revealed that an age ≥83 years, Charlson Comorbidity Index ≥2, prognostic nutritional index <46, and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with poor overall survival. The multivariate analysis identified Charlson Comorbidity Index ≥2 (hazard ratio: 2.26; 95% confidence interval (CI): 1.24–4.13; p = 0.0008) and NLR ≥3 (hazard ratio, 1.98; 95% CI: 1.02–3.81; p = 0.042) as independent prognostic factors.

Conclusions

CCI and NLR may be useful parameters for decision-making in older patients undergoing colorectal ESD.

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75岁及以上患者内镜下粘膜下解剖治疗结直肠肿瘤的预后因素和长期预后

背景：关于内镜下粘膜剥离（ESD）对老年结直肠肿瘤患者的长期疗效的研究有限。因此，在本研究中，我们旨在分析老年结直肠肿瘤患者行ESD的长期预后，并确定预后因素。方法回顾性分析单中心年龄≥75岁的结直肠肿瘤（腺瘤和Tis/T1结直肠癌）行ESD治疗的患者资料。采用Kaplan-Meier法和Cox比例风险模型分析影响总生存的预后因素。结果156例患者中，51例患者在随访期间死亡，其中2例死于结直肠癌。单因素分析显示，年龄≥83岁、Charlson共病指数≥2、预后营养指数≥46、中性粒细胞与淋巴细胞比值(NLR)≥3与总生存率差相关。多因素分析发现Charlson合并症指数≥2(风险比：2.26；95%置信区间（CI）： 1.24-4.13；p = 0.0008), NLR≥3(风险比1.98；95% ci: 1.02-3.81；P = 0.042)为独立预后因素。结论CCI和NLR可作为老年结肠ESD患者决策的参考参数。

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来源期刊

DEN open

CiteScore

1.30

自引率

0.00%

发文量