医学
结直肠癌
结肠切除术
结直肠外科
外科肿瘤学
危险系数
林奇综合征
比例危险模型
外科
回顾性队列研究
内科学
入射(几何)
癌症
腹部外科
生存分析
肿瘤科
置信区间
物理
DNA错配修复
光学
作者
N. Natarajan,Patrice Watson,Edibaldo Silva-Lopez,Henry T. Lynch
出处
期刊:Diseases of The Colon & Rectum
[Ovid Technologies (Wolters Kluwer)]
日期:2010-01-01
卷期号:53 (1): 77-82
被引量:93
标识
DOI:10.1007/dcr.0b013e3181c702de
摘要
PURPOSE: The purpose of the study was to determine the advantages and disadvantages of prophylactic/extended colectomy (subtotal colectomy) in patients with Lynch syndrome who manifest colorectal cancer. METHODS: A retrospective cohort using Creighton University's hereditary cancer database was used to identify cases and controls. Cases are patients who underwent subtotal colectomy, either with no colorectal cancer diagnosis (prophylactic) or at diagnosis of first colorectal cancer; controls for these 2 types of cases were, respectively, patients who underwent no colon surgery or those having limited resection at time of diagnosis of first colorectal cancer. The Kaplan-Meier and proportional hazard regression models from the Statistical Analysis Software program was used to calculate the difference in survival, time to subsequent colorectal cancer, and subsequent abdominal surgery between cases and controls. RESULTS: The event-free survival of our study did not reach 50%, so we used the event-free survival at 5 years as our parameter to compare the 2 groups. The event-free survival for subsequent colorectal cancer, subsequent abdominal surgery, and death was 94%, 84%, and 93%, respectively, for cases and 74%, 63%, and 88%, respectively, for controls. Times to subsequent colorectal cancer and subsequent abdominal surgery were significantly shorter in the control group (P < .006 and P < .04, respectively). No significant difference was identified with respect to survival time between the cases and controls. CONCLUSIONS: Even though no survival benefit was identified between the cases and controls the increased incidence of metachronous colorectal cancer and increased abdominal surgeries among controls warrant the recommendation of subtotal colectomy in patients with Lynch syndrome.
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