评估林奇综合征患者结肠和妇科降低风险手术的有效性。
Assessing Effectiveness of Colonic and Gynecological Risk Reducing Surgery in Lynch Syndrome Individuals.
作者信息
Dueñas Nuria, Navarro Matilde, Teulé Àlex, Solanes Ares, Salinas Mònica, Iglesias Sílvia, Munté Elisabet, Ponce Jordi, Guardiola Jordi, Kreisler Esther, Carballas Elvira, Cuadrado Marta, Matias-Guiu Xavier, de la Ossa Napoleón, Lop Joan, Lázaro Conxi, Capellá Gabriel, Pineda Marta, Brunet Joan
机构信息
Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain.
出版信息
Cancers (Basel). 2020 Nov 18;12(11):3419. doi: 10.3390/cancers12113419.
BACKGROUND
Colorectal (CRC) and endometrial cancer (EC) are the most common types of cancer in Lynch syndrome (LS). Risk reducing surgeries (RRS) might impact cancer incidence and mortality. Our objectives were to evaluate cumulative incidences of CRC, gynecological cancer and all-cause mortality after RRS in LS individuals.
METHODS
Retrospective analysis of 976 LS carriers from a single-institution registry. Primary endpoints were cumulative incidence at 75 years of cancer (metachronous CRC in 425 individuals; EC and ovarian cancer (OC) in 531 individuals) and all-cause mortality cumulative incidence, comparing extended (ES) vs. segmental surgery (SS) in the CRC cohort and risk reducing gynecological surgery (RRGS) vs. surveillance in the gynecological cohort.
RESULTS
Cumulative incidence at 75 years of metachronous CRC was 12.5% vs. 44.7% ( = 0.04) and all-cause mortality cumulative incidence was 38.6% vs. 55.3% ( = 0.31), for ES and SS, respectively. Cumulative, incidence at 75 years was 11.2% vs. 46.3% for EC ( = 0.001) and 0% vs. 12.7% for OC ( N/A) and all-cause mortality cumulative incidence was 0% vs. 52.7% ( N/A), for RRGS vs. surveillance, respectively.
CONCLUSIONS
RRS in LS reduces the incidence of metachronous CRC and gynecological neoplasms, also indicating a reduction in all-cause mortality cumulative incidence in females undergoing RRGS.
背景
结直肠癌（CRC）和子宫内膜癌（EC）是林奇综合征（LS）中最常见的癌症类型。降低风险手术（RRS）可能会影响癌症发病率和死亡率。我们的目标是评估LS患者接受RRS后结直肠癌、妇科癌症的累积发病率以及全因死亡率。
方法
对来自单一机构登记处的976名LS携带者进行回顾性分析。主要终点是75岁时癌症的累积发病率（425例患者发生异时性结直肠癌；531例患者发生子宫内膜癌和卵巢癌（OC））以及全因死亡率累积发病率，比较结直肠癌队列中的扩大手术（ES）与节段性手术（SS），以及妇科队列中的降低风险妇科手术（RRGS）与监测。
结果
对于ES和SS，75岁时异时性结直肠癌的累积发病率分别为12.5%和44.7%（P = 0.04），全因死亡率累积发病率分别为38.6%和55.3%（P = 0.31）。对于RRGS与监测，75岁时子宫内膜癌的累积发病率分别为11.2%和46.3%（P = 0.001），卵巢癌为0%和12.7%（无可用数据），全因死亡率累积发病率分别为0%和52.7%（无可用数据）。
结论
LS患者接受RRS可降低异时性结直肠癌和妇科肿瘤的发病率，也表明接受RRGS的女性全因死亡率累积发病率降低。
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