Provenzale D, Kowdley K V, Arora S, Wong J B
Tufts University School of Medicine, Division of Gastroenterology, Boston, Massachusetts, USA.
Gastroenterology. 1995 Oct;109(4):1188-96. doi: 10.1016/0016-5085(95)90578-2.
BACKGROUND & AIMS: The treatment of patients with long-standing ulcerative colitis involving the entire colon is controversial. The aim of this study was to examine the effectiveness of surveillance colonoscopy or prophylactic colectomy on colon cancer mortality in patients with chronic ulcerative colitis.
Using decision analysis, computer cohort simulation of patients with ulcerative colitis was performed to evaluate 17 strategies including no colonoscopic surveillance, surveillance at varying intervals, and prophylactic proctocolectomy with ileal pouch-anal anastomosis. The model examined which biopsy results (low-grade dysplasia, high-grade dysplasia, or cancer) should lead to proctocolectomy and ileal pouch-anal anastomosis. Published data on the incidence of cancer with ulcerative colitis, the sensitivity and specificity of colonoscopy with biopsy, the risks of colonoscopy and surgery, and the prognosis with colon cancer were used.
For a 30-year-old patient with pancolitis for 10 years, the model suggests that prophylactic colectomy would increase life expectancy by 2-10 months compared with surveillance and by 1.1-1.4 years compared with no surveillance. Surveillance would improve life expectancy by 7 months to 1.2 years compared with no surveillance. In sensitivity analysis, results were most affected by the cumulative incidence of cancer in patients with chronic ulcerative colitis.
Either surveillance or prophylactic colectomy should increase life expectancy in patients with ulcerative colitis.
对于全结肠型长期溃疡性结肠炎患者的治疗存在争议。本研究旨在探讨监测性结肠镜检查或预防性结肠切除术对慢性溃疡性结肠炎患者结肠癌死亡率的有效性。
采用决策分析方法，对溃疡性结肠炎患者进行计算机队列模拟，以评估17种策略，包括不进行结肠镜监测、不同间隔时间的监测以及预防性全直肠结肠切除术加回肠储袋肛管吻合术。该模型研究了哪些活检结果（低级别异型增生、高级别异型增生或癌症）应导致全直肠结肠切除术和回肠储袋肛管吻合术。使用了已发表的关于溃疡性结肠炎患者癌症发病率、结肠镜活检的敏感性和特异性、结肠镜检查和手术风险以及结肠癌预后的数据。
对于一名30岁、患有全结肠炎10年的患者，该模型表明，与监测相比，预防性结肠切除术可使预期寿命延长2至10个月，与不进行监测相比可延长1.1至1.4年。与不进行监测相比，监测可使预期寿命延长7个月至1.2年。在敏感性分析中，结果受慢性溃疡性结肠炎患者癌症累积发病率的影响最大。
监测或预防性结肠切除术均应能提高溃疡性结肠炎患者的预期寿命。
