全腹结肠切除术在治疗遗传性诊断为林奇综合征的结直肠癌患者中具有成本效益。
Total abdominal colectomy is cost-effective in treating colorectal cancer in patients with genetically diagnosed Lynch Syndrome.
机构信息
Department of Surgery, University Hospital Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Department of Surgery, Ochsner Medical Center, 17050 Medical Center Drive, Baton Rouge, LA, 70816, USA.
出版信息
Am J Surg. 2019 Nov;218(5):928-933. doi: 10.1016/j.amjsurg.2019.03.011. Epub 2019 Mar 16.
BACKGROUND
Lynch syndrome (LS) has a 80% lifetime risk of developing colorectal cancer and metachronous cancer. No studies have examined the quality adjusted life expectancy after SEG or TAC for LS patients, which this study was aiming for. If TAC offers a higher quality adjusted life year (QALY) to SEG in LS patients, preoperative diagnosis of LS is critical as it alters the recommended surgical procedure.
METHODS
A Markov decision tree was constructed using Treeage software to compare QALY of LS patients following SEG or TAC. Probabilities, cost, and utility were obtained from literature. Cost-effectiveness analyses were performed.
RESULTS
TAC dominates SEG as both the life-saving and cost-saving strategy. TAC dominated SEG on QALY (17.80 vs 17.13 QALY) for a cohort of LS patients diagnosed at an average of 30 year old and followed every 2 years after initial surgery.
CONCLUSIONS
We conclude that TAC as the primary surgical option for LS patients diagnosed with Stage I-III colon cancer is cost-effective. Further cost-effectiveness study is recommended to include extra-colonic malignancies in LS patients.
背景
林奇综合征（LS）终生患结直肠癌和异时性癌症的风险为 80%。没有研究探讨 LS 患者接受 SEG 或 TAC 后的质量调整预期寿命，本研究旨在探讨这一问题。如果 TAC 为 LS 患者提供更高的质量调整生命年（QALY），则 LS 的术前诊断至关重要，因为它会改变推荐的手术程序。
方法
使用 Treeage 软件构建了一个马尔可夫决策树，以比较 SEG 或 TAC 后 LS 患者的 QALY。概率、成本和效用来自文献。进行了成本效益分析。
结果
TAC 作为挽救生命和节省成本的策略，优于 SEG。对于一组平均在 30 岁时被诊断为 LS 并在初始手术后每两年随访一次的患者队列，TAC 在 QALY（17.80 比 17.13 QALY）方面优于 SEG。
结论
我们的结论是，对于被诊断患有 I-III 期结肠癌的 LS 患者，TAC 作为主要手术选择具有成本效益。建议进一步进行成本效益研究，以纳入 LS 患者的结外恶性肿瘤。
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