Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery.
Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery.
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DOI：
10.1136/gut.2010.228056
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发表时间：
2011-07
期刊：
影响因子：
24.5
通讯作者：
Jenkins MA
中科院分区：
文献类型：
--
作者：
Parry S;Win AK;Parry B;Macrae FA;Gurrin LC;Church JM;Baron JA;Giles GG;Leggett BA;Winship I;Lipton L;Young GP;Young JP;Lodge CJ;Southey MC;Newcomb PA;Le Marchand L;Haile RW;Lindor NM;Gallinger S;Hopper JL;Jenkins MA
对携带错配修复基因突变的Lynch综合征患者进行结肠癌手术治疗是有争议的。决定切除或多或少的结肠涉及考虑异时性结直肠癌（CRC）的相对高风险，以及更广泛的手术的影响。我们的目的是评估和比较林奇综合征患者因首次结肠癌接受节段性或广泛（次全或全）切除术后发生异时性结直肠癌的风险。对来自结肠癌家族登记处的382名MMR基因突变携带者（172名MLH 1，167名MSH 2，23名MSH 6和20名PMS 2）进行了异时性CRC的风险评估，这些患者使用回顾性队列分析进行了首次结肠癌手术。采用Kaplan-Meier法计算异时性结直肠癌的累积危险度。通过考克斯比例风险回归评估异时性结直肠癌的危险因素。50例接受广泛结肠切除术的受试者均未被诊断为异时性CRC（发病率0.0; 95%CI 0.0-7.2/1000人-年）。在332例接受节段性切除术的受试者中，74例（22%）被诊断为异时性CRC（发病率23.6; 95%CI 18.8-29.7/1000人-年）。行节段性切除术的患者，其发生率在统计学上高于行广泛手术的患者（P <0.001）。异时性结直肠癌的累积风险在节段性结肠切除术后10年为16%（95%CI 10-25%），20年为41%（95%CI 30-52%），30年为62%（95%CI 50-77%）。每切除10 cm肠，异时性结直肠癌的风险降低31%（95%CI 12-46%; P 0.002）。与接受不太广泛手术的患者相比，接受更广泛结肠切除术治疗的首次结肠癌Lynch综合征患者发生异时性CRC的风险较低。这一发现将更好地告知关于初次手术切除范围的决策。
Surgical management of colon cancer for patients with Lynch Syndrome who carry a mismatch repair gene mutation is controversial. The decision to remove more or less of the colon involves the consideration of a relatively high risk of metachronous colorectal cancer (CRC) with the impact of more extensive surgery. Our aim was to estimate and compare the risks of metachronous CRC for Lynch Syndrome patients undergoing either segmental or extensive (subtotal or total) resection for first colon cancer. Risk of metachronous CRC was estimated for 382 MMR gene mutation carriers (172 MLH1, 167 MSH2, 23 MSH6 and 20 PMS2) from the Colon Cancer Family Registry, who had surgery for their first colon cancer using retrospective cohort analysis. Age-dependent cumulative risks of metachronous CRC were calculated using the Kaplan-Meier method. Risk factors for metachronous CRC were assessed by a Cox proportional hazards regression. None of 50 subjects who had extensive colectomy was diagnosed with metachronous CRC (incidence rate 0.0; 95%CI 0.0–7.2 per 1000 person-years). Of 332 subjects who had segmental resections, 74 (22%) were diagnosed with metachronous CRC (incidence rate 23.6; 95%CI 18.8–29.7 per 1000 person-years). For those who had segmental resections, incidence was statistically higher than for those who had extensive surgery (P <0.001). Cumulative risk of metachronous CRC was 16% (95%CI 10–25%) at 10 years, 41% (95%CI 30–52%) at 20 years and 62% (95%CI 50–77%) at 30 years after segmental colectomy. Risk of metachronous CRC reduced by 31% (95%CI 12–46%; P 0.002) for every 10 cm of bowel removed. Lynch Syndrome patients with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC compared with those receiving less extensive surgery. This finding will better inform decision-making regarding the extent of primary surgical resection.
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影响因子：
12.6
作者：
Jenkins, MA;Baglietto, L;Southey, MC
通讯作者：
Southey, MC
影响因子：
9
作者：
RodriguezBigas, MA;Vasen, HFA;Cutait, R
通讯作者：
Cutait, R
影响因子：
120.7
作者：
Chen, Sining;Wang, Wenyi;Parmigiani, Giovanni
通讯作者：
Parmigiani, Giovanni
影响因子：
3.9
作者：
You, Y. Nancy;Chua, Heidi K.;Harrington, Jeffrey
通讯作者：
Harrington, Jeffrey
影响因子：
29.4
作者：
Vasen, HFA;Watson, P;Lynch, HT
通讯作者：
Lynch, HT