Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
Pacific Gastroenterology Associates, Vancouver, BC, Canada.
Can J Gastroenterol Hepatol. 2017;2017:9625638. doi: 10.1155/2017/9625638. Epub 2017 Jul 2.
Lynch Syndrome (LS) is the most common cause of inherited colorectal cancer (CRC). In British Columbia, most centres still use clinical criteria (Amsterdam II, Revised Bethesda, or the BC Cancer Agency's criteria) to determine who should undergo further first-line testing in the form of microsatellite instability or immunohistochemistry staining. Given the limitations with this strategy, LS is thought to be underrecognized.
To investigate whether LS is truly underrecognized when compared to the reported prevalence.
A retrospective chart review of all CRC cases diagnosed at St. Paul's Hospital from 2010 to 2013 was conducted.
246 patients met inclusion criteria. 76% (83/109) with a family history of malignancy were unable to recall the specific malignancy or age of diagnosis. 18% (43/235) were only asked about a history of gastrointestinal related malignancy and 26% (65/246) met at least one of the three criteria but only 21% (13/63) received further investigation. Only 1.6% (4/246) had LS compared to the reported prevalence of 2-5% of all CRC cases.
This data supports our hypothesis that LS is underrecognized. Issues at the patient, physician, and systems level need to be evaluated to determine where the limitations preventing appropriate testing are occurring.
林奇综合征（LS）是遗传性结直肠癌（CRC）最常见的原因。在不列颠哥伦比亚省，大多数中心仍使用临床标准（阿姆斯特丹 II 标准、修订贝塞斯达标准或不列颠哥伦比亚癌症署标准）来确定谁应该接受进一步的一线测试，形式为微卫星不稳定性或免疫组织化学染色。鉴于这种策略存在局限性，LS 被认为是被低估的。
调查与报告的流行率相比，LS 是否确实被低估。
对 2010 年至 2013 年在圣保罗医院诊断的所有 CRC 病例进行了回顾性图表审查。
246 名患者符合纳入标准。有恶性肿瘤家族史的患者中，76%（83/109）无法回忆起具体的恶性肿瘤或诊断年龄。18%（43/235）仅被问及胃肠道相关恶性肿瘤史，26%（65/246）符合至少一项三项标准，但只有 21%（13/63）接受了进一步调查。仅 1.6%（4/246）患有 LS，而所有 CRC 病例的报告流行率为 2-5%。
这些数据支持我们的假设，即 LS 被低估了。需要评估患者、医生和系统层面的问题，以确定哪些限制了适当测试的发生。
