Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis
Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis
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DOI：
10.1136/gut.40.6.716
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发表时间：
1997-06-01
期刊：
影响因子：
24.5
通讯作者：
deRuiter, P
中科院分区：
文献类型：
--
作者：
Vasen, HFA;Bulow, S;deRuiter, P
背景-家族性腺瘤性息肉病患者不仅在结直肠中发生腺瘤的风险很高，而且相当多的患者也在十二指肠中发生息肉。由于十二指肠息肉的治疗极其困难，并且不知道有多少患者最终发展为十二指肠癌，因此上消化道监测的价值不确定。目的-(1)评估大量息肉患者患十二指肠癌的累积风险。 (2) 开发一个决策模型来确定监测是否会导致预期寿命增加。方法-对 155 个荷兰息肉病家庭（包括 601 名息肉病患者）和 142 个丹麦家庭（包括 376 名患者）进行风险分析。观察时间是从出生到最后一次接触、死亡、十二指肠癌诊断或研究结束日期的日期。结果-七名荷兰患者和五名丹麦患者患上了十二指肠癌。在荷兰系列中，70 岁时患这种癌症的终生风险为 4%（95% 置信区间 1-7%），在丹麦系列中为 3%（95% 置信区间 0-6%）。决策分析表明，监测使预期寿命延长了七个月。结论——上消化道监测使预期寿命适度延长。未来的研究应评估预期寿命的增加是否超过内镜检查和近端胰十二指肠切除术的发病率。
Background-Patients with familial adenomatous polyposis are not only at high risk of developing adenomas in the colorectum but a substantial number of patients also develop polyps in the duodenum. Because treatment of duodenal polyps is extremely difficult and it is unknown how many patients ultimately develop duodenal cancer, the value of surveillance of the upper digestive tract is uncertain.Aims-(1) To assess the cumulative risk of duodenal cancer in a large series of polyposis patients. (2) To develop a decision model to establish whether surveillance would lead to increased life expectancy.Methods-Risk analysis was performed in 155 Dutch polyposis families including 601 polyposis patients, and 142 Danish families including 376 patients. Observation time was from birth until date of last contact, death, diagnosis of duodenal cancer, or closing date of the study.Results-Seven Dutch and five Danish patients developed duodenal cancer. The lifetime risk of developing this cancer by the age of 70 was 4% (95% confidence interval 1-7%) in the Dutch series and 3% (95% confidence interval 0-6%) in the Danish series. Decision analysis showed that surveillance led to an increase in life expectancy by seven months.Conclusions-Surveillance of the upper digestive tract led to a moderate gain in life expectancy. Future studies should evaluate whether this increase in Life expectancy outweighs the morbidity of endoscopic examination and proximal pancreatico duodenectomy.