Xu Weimin, Ou Weijun, Fu Jihong, Gu Yubei, Cui Long, Zhong Jie, Du Peng
Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
Department of Gastroenterology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Gastroenterol Rep (Oxf). 2021 May 29;9(5):435-442. doi: 10.1093/gastro/goab022. eCollection 2021 Oct.
Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) was the first choice for the surgical treatment of the ulcerative colitis (UC) patients. The data on the predictive value of the ulcerative colitis endoscopic index of severity (UCEIS) for the need for IPAA in UC patients is scarce. We aimed to establish the UCEIS cut-off value to further analyse whether the UCEIS cut-off was suitable for predicting the need for IPAA in UC patients.
The clinical data of UC patients from June 1986 to March 2020 at our institute were retrospectively assessed. The UCEIS scores recorded at the time of the first colonoscopy after hospitalization were used in the study. Receiver operating characteristic curve analysis was performed to determine the UCEIS cut-off value for predicting the need for IPAA.
A total of 283 UC patients were included in the study, with a median UCEIS of 4. During a median follow-up of 13 years, 80 patients (28.3%) received surgery invention, among whom 75 (93.8%) underwent IPAA surgery and 5 (6.2%) received subtotal colectomy with permanent ostomy. A UCEIS cut-off of 6 had the most significant area under the curve of 0.769 for predicting the need for IPAA (<0.001), with a sensitivity of 72.0% and specificity of 81.8%. UCEIS ≥6 was an independent predictive factor for the need for IPAA (<0.001) and malignant transformation (=0.010). Patients with UCEIS ≥6 had a significantly shorter IPAA-free survival time than those with UCEIS <6 (<0.001).
UCEIS ≥6 may be a threshold value for decision-making for IPAA and should be recommended for UC patients for reducing the incidence of malignant transformation.
全结直肠切除回肠储袋肛管吻合术（IPAA）是溃疡性结肠炎（UC）患者外科治疗的首选。关于UC患者中溃疡性结肠炎内镜严重程度指数（UCEIS）对IPAA需求的预测价值的数据较少。我们旨在确定UCEIS的临界值，以进一步分析该临界值是否适用于预测UC患者对IPAA的需求。
回顾性评估1986年6月至2020年3月我院UC患者的临床资料。研究采用住院后首次结肠镜检查时记录的UCEIS评分。进行受试者操作特征曲线分析以确定预测IPAA需求的UCEIS临界值。
本研究共纳入283例UC患者，UCEIS中位数为4。中位随访13年期间，80例患者（28.3%）接受了手术干预，其中75例（93.8%）接受了IPAA手术，5例（6.2%）接受了次全结肠切除并永久性造口术。UCEIS临界值为6时，预测IPAA需求的曲线下面积最大，为0.769（<0.001），敏感性为72.0%，特异性为81.8%。UCEIS≥6是IPAA需求（<0.001）和恶变（=0.010）的独立预测因素。UCEIS≥6的患者无IPAA生存时间明显短于UCEIS<6的患者（<0.001）。
UCEIS≥6可能是IPAA决策的阈值，建议UC患者采用以降低恶变发生率。
