Toh James Wei Tatt, Hui Nicholas, Collins Geoffrey, Phan Kevin
Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia.
Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.
Surgery. 2022 Nov;172(5):1315-1322. doi: 10.1016/j.surg.2022.06.013. Epub 2022 Aug 26.
Lynch syndrome is associated with the most common form of heritable bowel cancer. There remains limited level 1 evidence on survival outcomes and rate of metachronous tumor associated with Lynch syndrome colorectal cancer.
A systematic literature search of original studies was performed on Ovid searching MEDLINE, Embase, Cochrane Database of Systematic Reviews, American College of Physicians ACP Journal Club, Database of Abstracts of Reviews of Effects DARE, and Clinical Trials databases from inception of database to February 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. The data were pooled using a random-effects model. All of the P values were 2-tailed, and statistical analysis was performed using RevMan v. 5.3 Cochrane Collaboration.
From 1,942 studies, 15 studies met the inclusion criteria and were included for qualitative and quantitative synthesis. The five-year overall survival was 89.5% (82.0-94.1%), P < .01; I = 89%. The ten-year overall survival was 80.5% (68.7-88.6%), P < .01; I = 81%. The fifteen-year overall survival was 70% (33.7%-91.5%), P < .01; I = 93%. Univariate meta-regression analysis showed no statistically significant difference in 5-year overall survival by sex, age, MLH1, MSH2, MSH6, nor tumor location (right versus left colon). The metachronous tumor rate was 12% to 33% with a follow-up period of up to 15 years, significantly lower in patients who underwent subtotal/total colectomy (0-6%).
The overall survival of patients with colorectal cancer with Lynch syndrome was approximately 90% at 5 years, 80% at 10 years, and 70% at 15 years. The metachronous tumor rate was approximately 10% to 30% at up to 15 years, significantly improved by subtotal/total colectomy.
林奇综合征与遗传性结直肠癌最常见的形式相关。关于林奇综合征结直肠癌的生存结局和异时性肿瘤发生率，一级证据仍然有限。
在Ovid上对原始研究进行系统文献检索，检索MEDLINE、Embase、Cochrane系统评价数据库、美国医师学会《ACP杂志俱乐部》、效果评价文摘数据库（DARE）以及从数据库建立至2021年2月的临床试验数据库。遵循系统评价和Meta分析的首选报告项目（PRISMA）报告指南。使用随机效应模型汇总数据。所有P值为双侧，使用RevMan v. 5.3 Cochrane协作网进行统计分析。
从1942项研究中，15项研究符合纳入标准，被纳入定性和定量综合分析。5年总生存率为89.5%（82.0 - 94.1%），P <.01；I² = 89%。10年总生存率为80.5%（68.7 - 88.6%），P <.01；I² = 81%。15年总生存率为70%（33.7% - 91.5%），P <.01；I² = 93%。单因素Meta回归分析显示，5年总生存率在性别、年龄、错配修复蛋白MLH1、MSH2、MSH6以及肿瘤位置（右半结肠与左半结肠）方面无统计学显著差异。异时性肿瘤发生率在长达15年的随访期内为12%至33%，在接受次全/全结肠切除术的患者中显著降低（0 - 6%）。
林奇综合征结直肠癌患者的5年总生存率约为90%，10年约为80%，15年约为70%。长达15年的异时性肿瘤发生率约为10%至30%，次全/全结肠切除术可使其显著降低。
