MSHS, Department of Surgery/Division of Colorectal Surgery, Keck School of Medicine/University of Southern California, 1441 Eastlake Ave, Ste 7418, Los Angeles, CA 90033, USA.
J Clin Oncol. 2010 Mar 1;28(7):1175-80. doi: 10.1200/JCO.2009.25.9812. Epub 2010 Feb 1.
In choosing the appropriate surgical option for patients with colon cancer and Lynch syndrome, goals of treatment are to maximize life expectancy while preserving quality of life. This study constructs a decision model that encompasses these two related considerations.
We constructed a state-transition (Markov) model based on assumptions obtained from available data sources and published literature. Two strategies were considered for the treatment of colon cancer in a patient with Lynch syndrome: segmental colectomy (SEG) and total abdominal colectomy (TAC) with ileorectal anastomosis. Quality-adjusted life years (QALYs) were calculated based on utility states for patients based on the colectomy they received. Multiple sensitivity analyses were planned to examine the impact of each assumption on model results.
For young (30-year-old) patients with Lynch syndrome, mean survival was slightly better with TAC than with SEG (34.8 v 35.5 years). When QALYs were considered, the two strategies were approximately equivalent, with QALYs per patient of 21.5 for SEG and 21.2 for TAC. With advancing age, SEG becomes a more favorable strategy. Results of our model were most sensitive to the utility state of TAC (relative to SEG), rates of metachronous occurrence, and stage of cancer at the time of such occurrence.
SEG and TAC are approximately equivalent strategies for patients with colon cancer and Lynch syndrome. The decision regarding which operation is preferable should be made on the basis of patient factors and preferences, with special emphasis on age and the ability of the patient to utilize intensive surveillance.
在为患有结肠癌和林奇综合征的患者选择合适的手术方案时，治疗目标是在提高预期寿命的同时保留生活质量。本研究构建了一个决策模型，涵盖了这两个相关的考虑因素。
我们基于可获得的数据来源和已发表的文献假设构建了一个状态转移（Markov）模型。对于林奇综合征患者结肠癌的治疗，考虑了两种策略：节段性结肠切除术（SEG）和全腹结肠切除术（TAC）联合回直肠吻合术。根据患者接受的结肠切除术，基于效用状态计算了质量调整生命年（QALY）。计划进行多次敏感性分析，以检查每个假设对模型结果的影响。
对于患有林奇综合征的年轻（30 岁）患者，TAC 的平均生存时间略长于 SEG（34.8 年 vs. 35.5 年）。当考虑 QALY 时，两种策略大致相当，SEG 组每个患者的 QALY 为 21.5，TAC 组为 21.2。随着年龄的增长，SEG 成为更有利的策略。我们模型的结果对 TAC（相对于 SEG）的效用状态、同时发生的发生率以及发生时癌症的分期最为敏感。
SEG 和 TAC 是治疗结肠癌和林奇综合征患者的大致相当的策略。哪种手术更优的决策应基于患者的因素和偏好做出，特别要强调年龄和患者接受强化监测的能力。
