Natarajan Nagendra, Watson Patrice, Silva-Lopez Edibaldo, Lynch Henry T
Hematology and Medical Oncology, University of Louisville, Louisville, Kentucky 40202, USA.
Dis Colon Rectum. 2010 Jan;53(1):77-82. doi: 10.1007/DCR.0b013e3181c702de.
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.
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.
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.
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.
本研究旨在确定对患有结直肠癌的林奇综合征患者进行预防性/扩大结肠切除术（次全结肠切除术）的利弊。
利用克里顿大学的遗传性癌症数据库进行回顾性队列研究以确定病例和对照。病例为接受次全结肠切除术的患者，这些患者要么未被诊断为结直肠癌（预防性手术），要么在首次诊断为结直肠癌时接受手术；这两类病例的对照分别为未接受结肠手术的患者或在首次诊断为结直肠癌时接受有限切除术的患者。使用统计分析软件程序中的Kaplan-Meier法和比例风险回归模型来计算病例组和对照组在生存率、后续结直肠癌发生时间以及后续腹部手术方面的差异。
我们研究的无事件生存率未达到50%，因此我们将5年时的无事件生存率作为参数来比较两组。病例组后续结直肠癌、后续腹部手术和死亡的无事件生存率分别为94%、84%和93%，对照组分别为74%、63%和88%。对照组后续结直肠癌和后续腹部手术的发生时间显著更短（分别为P < 0.006和P < 0.04）。病例组和对照组在生存时间方面未发现显著差异。
尽管病例组和对照组之间未发现生存获益，但对照组中异时性结直肠癌发病率增加以及腹部手术增加，这使得推荐对林奇综合征患者进行次全结肠切除术。
