优化的结肠镜筛查方案对林奇综合征患者的影响：法国一个专业网络的6年结果
Impact of an optimized colonoscopic screening program for patients with Lynch syndrome: 6-year results of a specialized French network.
作者信息
Perrod Guillaume, Samaha Elia, Rahmi Gabriel, Khater Sherine, Abbes Leila, Savale Camille, Perkins Geraldine, Zaanan Aziz, Chatellier Gilles, Malamut Georgia, Cellier Christophe
机构信息
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'hépato-gastro-entérologie et d'endoscopie, Paris, FranceFaculté de médecine René Descartes, Paris, France.
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'hépato-gastro-entérologie et d'endoscopie, Paris, France.
出版信息
Therap Adv Gastroenterol. 2018 May 27;11:1756284818775058. doi: 10.1177/1756284818775058. eCollection 2018.
BACKGROUND
Despite colonoscopic screening, colorectal cancer (CRC) remains frequent in patients with Lynch syndrome (LS). The objective of this study was to evaluate the impact of an optimized colorectal screening program within a French dedicated network.
METHODS
All LS patients followed at our institution were consecutively included in the Prédisposition au Cancer Colorectal-Ile de France (PRED-IdF) network. Patients were offered an optimized screening program allowing an adjustment of the interval between colonoscopies, depending on bowel preparation, chromoendoscopy achievement and adenoma detection. Colonoscopies were defined as optimal when all the screening criteria were respected. We compared colonoscopy quality and colonoscopy detection rate before and after PRED-IdF inclusion, including polyp detection rate (PDR), adenoma detection rate (ADR) and cancer detection rate (CDR).
RESULTS
Between January 2010 and January 2016, 144 LS patients were consecutively included (male/female = 50/94, mean age = 51 ± 13 years and mutations: MLH1 = 39%, MSH2 = 44%, MSH6 = 15%, PMS2 = 1%). A total of 564 colonoscopies were analyzed, 353 after inclusion and 211 before. After PRED-IdF inclusion, 98/144 (68%) patients had optimal screening colonoscopies 33/132 (25%) before ( < 0.0005). The optimal colonoscopy rate was 304/353 (86%) after inclusion 87/211 (41%) before, ( < 0.0001). PRED-IdF inclusion was associated with a reduction of CRC occurrence with a CDR of 1/353 (0.3%) after inclusion 6/211 (2.8%) before ( = 0.012). ADR and PDR were 99/353 (28%) 60/211 (28.8%) ( > 0.05) and 167/353 (48.1%) 90/211 (42.2%) ( > 0.05), respectively after and before inclusion.
CONCLUSIONS
An optimized colonoscopic surveillance program in LS patients seems to improve colonoscopic screening quality and might possibly decrease colorectal interval cancer occurrence. Long-term cohort studies are needed to confirm these results.
背景
尽管进行了结肠镜筛查，但林奇综合征（LS）患者的结直肠癌（CRC）仍然很常见。本研究的目的是评估法国一个专门网络内优化的结直肠癌筛查项目的影响。
方法
在我们机构接受随访的所有LS患者都被连续纳入法国结直肠癌易感性-法兰西岛（PRED-IdF）网络。为患者提供了一个优化的筛查项目，该项目可以根据肠道准备情况、色素内镜检查结果和腺瘤检出情况调整结肠镜检查之间的间隔。当所有筛查标准都得到满足时，结肠镜检查被定义为最佳。我们比较了纳入PRED-IdF前后的结肠镜检查质量和结肠镜检查检出率，包括息肉检出率（PDR）、腺瘤检出率（ADR）和癌症检出率（CDR）。
结果
2010年1月至2016年1月期间，连续纳入144例LS患者（男/女=50/94，平均年龄=51±13岁，突变情况：MLH1=39%，MSH2=44%，MSH6=15%，PMS2=1%）。共分析了564次结肠镜检查，纳入后353次，纳入前2次。纳入PRED-IdF后，98/144（68%）的患者进行了最佳筛查结肠镜检查，纳入前为33/132（25%）（P<0.0005）。纳入后最佳结肠镜检查率为304/353（86%），纳入前为87/211（41%）（P<0.0001）。纳入PRED-IdF与CRC发生率的降低相关，纳入后CDR为1/353（0.3%），纳入前为6/211（2.8%）（P=0.012）。纳入前后ADR分别为99/353（28%）和60/211（28.8%）（P>0.05），PDR分别为167/353（48.1%）和90/211（42.2%）（P>0.05）。
结论
LS患者优化的结肠镜监测项目似乎可以提高结肠镜筛查质量，并可能降低结直肠癌间期癌的发生率。需要长期队列研究来证实这些结果。
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