A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn's disease after ileocolonic resection.
A nomogram incorporating ileal and anastomotic lesions separately to predict the long-term outcome of Crohn's disease after ileocolonic resection.
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DOI：
10.1177/17562848231198933
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发表时间：
2023
影响因子：
4.2
通讯作者：
Mao, Ren
中科院分区：
文献类型：
--
作者：
Xiong, Shanshan;He, Jinshen;Chen, Baili;He, Yao;Zeng, Zhirong;Chen, Minhu;Chen, Zhihui;Qiu, Yun;Mao, Ren
根据新生末端回肠和吻合处病变的严重程度，Rutgeorge评分（RS）被广泛用于预测克罗恩病（CD）回结肠切除术后的术后复发（RS i0-i4）。然而，吻合口溃疡的价值仍然存在争议。我们的目的是建立一个列线图模型，分别纳入回肠和吻合口病变，以预测CD回肠或回结肠切除术后的长期结果。本回顾性队列研究共纳入136例CD患者。纳入了连续接受回肠或回结肠切除术并在手术后1年内进行术后回结肠镜评价的CD患者。主要终点为术后临床复发（CR）。应用分离回肠和吻合口病变的内镜分类（Ix为新末端回肠病变; Ax为吻合口病变）。构建诺模图预测CR。通过受试者工作特征（ROC）曲线和决策曲线分析（DCA）评价模型的性能。在中位随访26.9（四分位距，11.4 - 55.2）个月内，在47.1%（n = 64）的患者中观察到CR。术后第一次内窥镜检查评估的RS ≥ 2患者的CR风险显著高于RS ≥ 1患者（p <0.001）。此外，有回肠病变的患者（I1 - 4）的累积CR率显著高于无回肠病变的患者（I0）（p <0.001）。此外，有吻合口病变的患者（A1 - 3）的CR率显著高于无吻合口病变的患者（A0）（p = 0.002）。将术后回肠或吻合口病变评分、性别、L2亚型和肛周疾病纳入列线图。DCA分析表明，与传统RS评分相比，列线图对CR的获益更高，尤其是在索引内镜检查后24 - 60个月的时间范围内。分别将术后回肠和吻合口病变纳入诺模图，以预测CD患者的CR，这可能是识别需要及时术后干预的高风险患者的实用工具。
The Rutgeerts score (RS) is widely used to predict postoperative recurrence after ileocolonic resection for Crohn’s disease (CD) based on the severity of lesions at the neoterminal ileum and anastomosis (RS i0–i4). However, the value of anastomotic ulcers remains controversial. Our aim was to establish a nomogram model incorporating ileal and anastomotic lesions separately to predict the long-term outcomes of CD after ileal or ileocolonic resection. A total of 136 patients with CD were included in this retrospective cohort study. Consecutive CD patients who underwent ileal or ileocolonic resections with postoperative ileocolonoscopy evaluation within 1 year after the surgery were included. The primary endpoint was postoperative clinical relapse (CR). An endoscopic classification separating ileal and anastomotic lesions was applied (Ix for neoterminal ileum lesions; Ax for anastomotic lesions). A nomogram was constructed to predict CR. The performance of the model was evaluated by the receiver-operating characteristic (ROC) curve and decision curve analysis (DCA). CR was observed in 47.1% (n = 64) of patients within a median follow-up of 26.9 (interquartile range, 11.4–55.2) months. The risk of CR was significantly higher in patients with an RS ⩾ i2 assessed by the first postoperative endoscopy compared with patients with an RS ⩽ i1 (p < 0.001). Moreover, the cumulative rate of CR was significantly higher in patients with ileal lesions (I1–4) compared with patients without (I0) (p < 0.001). Besides, patients with anastomotic lesions (A1–3) had significantly higher rates of CR than patients without (A0) (p = 0.002). A nomogram, incorporating scores of postoperative ileal or anastomotic lesions, sex, L2-subtype and perianal disease, was established. The DCA analysis indicated that the nomogram had a higher benefit for CR, especially at the timeframe of 24–60 months after index endoscopy, compared to the traditional RS score. A nomogram incorporating postoperative ileal and anastomotic lesions separately was developed to predict CR in CD patients, which may serve as a practical tool to identify high-risk patients who need timely postoperative intervention.
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影响因子：
3.1
作者：
Kim, Jin Yong;Park, Sang Hyoung;Yang, Suk-Kyun
通讯作者：
Yang, Suk-Kyun
影响因子：
24.5
作者：
RUTGEERTS, P;GEBOES, K;COREMANS, G
通讯作者：
COREMANS, G
影响因子：
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作者：
Hammoudi, Nassim;Auzolle, Claire;Allez, Matthieu
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Allez, Matthieu
影响因子：
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作者：
Dittrich, Alexandra E;Sutton, Reed Taylor;Kroeker, Karen I
通讯作者：
Kroeker, Karen I
影响因子：
3.1
作者：
Bayart, P.;Duveau, N.;Pariente, B.
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Pariente, B.