Gage T P
J Clin Gastroenterol. 1986 Feb;8(1):50-7. doi: 10.1097/00004836-198602000-00011.
Chronic ulcerative colitis is associated with a high risk of colon cancer. The most appropriate management--prophylactic proctocolectomy or medical surveillance--is, at present, unclear. Recent reports suggest that the presence of colonic dysplasia or "precancer" on endoscopic biopsy may be a reliable predictor of concurrent or future colon cancer. To assess the value of colonic dysplasia in managing colitis patients, I applied decision analytic techniques to currently available data regarding the sensitivity and specificity of colonic dysplasia in colitis patients. Such analysis shows that management based on biopsy for colonic dysplasia, rather than prophylactic proctocolectomy for all colitis patients, will maximize 5-year survival. Sensitivity analysis suggests that management is primarily determined by the sensitivity of biopsy-diagnosed dysplasia--elective prophylactic surgery would be preferred only when sensitivity of dysplasia on biopsy is less than or equal to 0.70 at 20 years, or less than or equal to 0.85 at 30 years of colitis, and changing surgical mortality and survival benefit from early diagnosis within a range established by previous studies affects management decisions only when sensitivity of dysplasia is at the lower end of its reported range.
慢性溃疡性结肠炎与结肠癌的高风险相关。目前，最恰当的处理方式——预防性全直肠结肠切除术还是医学监测——尚不清楚。近期报告表明，内镜活检时结肠发育异常或“癌前病变”的存在可能是同时期或未来结肠癌的可靠预测指标。为评估结肠发育异常在处理结肠炎患者中的价值，我将决策分析技术应用于目前关于结肠炎患者结肠发育异常的敏感性和特异性的可用数据。此类分析表明，基于结肠发育异常活检的处理方式，而非对所有结肠炎患者进行预防性全直肠结肠切除术，将使5年生存率最大化。敏感性分析表明，处理方式主要由活检诊断发育异常的敏感性决定——仅当结肠炎20年时发育异常活检的敏感性小于或等于0.70，或30年时小于或等于0.85，且手术死亡率和早期诊断带来的生存获益在先前研究确定的范围内变化时，选择性预防性手术才会更受青睐，而发育异常的敏感性处于其报告范围的下限会影响处理决策。
