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Web-Based Model for Predicting Time to Surgery in Young Patients with Familial Adenomatous Polyposis: An Internally Validated Study.
The American Journal of Gastroenterology ( IF 8.0 ) Pub Date : 2018-10-17 , DOI: 10.1038/s41395-018-0278-2 Shashank Sarvepalli 1 , Carol A Burke 1, 1, 1 , Marc Monachese 1 , Rocio Lopez 1, 1 , Brandie H Leach 1, 1 , Lisa Laguardia 1 , Margaret OʼMalley 1 , Matthew F Kalady 1, 1 , James M Church 1, 1
The American Journal of Gastroenterology ( IF 8.0 ) Pub Date : 2018-10-17 , DOI: 10.1038/s41395-018-0278-2 Shashank Sarvepalli 1 , Carol A Burke 1, 1, 1 , Marc Monachese 1 , Rocio Lopez 1, 1 , Brandie H Leach 1, 1 , Lisa Laguardia 1 , Margaret OʼMalley 1 , Matthew F Kalady 1, 1 , James M Church 1, 1
Affiliation
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INTRODUCTION
The timing of prophylactic colorectal surgery in patients with familial adenomatous polyposis (FAP) is based on the immediacy of the colorectal cancer risk. The ability to predict the need for surgery may help patients and their families plan in the context of life events and CRC risk. We created a model to predict the likelihood of surgery within 2 and 5 years of first colonoscopy at our institution.
METHODS
A single institution hereditary colorectal syndrome (Cologene™) database was interrogated for all patients with FAP having a deleterious APC mutation. Patients with first colonoscopy after age 30 and before year 2000 were excluded. Cox regression analysis was done to assess multiple factors associated with surgery, followed by stepwise Cox regression analysis to select an optimal model. Receiver operator curve (ROC) analysis was performed to assess the model.
RESULTS
A total of 211 (53% female) patients were included. Forty-five percent underwent surgery after an average of 3.8 years of surveillance. The final model was created based on initial clinical characteristics (age, gender, BMI, family history of desmoids, genotype-phenotype correlation), initial colonoscopic characteristics (number of polyps, polyp size, presence of high-grade dysplasia); and on clinical events (chemoprevention and polypectomy). AUC was 0.87 and 0.84 to predict surgery within 2 and 5 years, respectively. The final model can be accessed at this website: http://app.calculoid.com/#/calculator/29638 .
CONCLUSION
This web-based tool allows clinicians to stratify patients' likelihood of colorectal surgery within 2 and 5 years of their initial examination, based on clinical and endoscopic features, and using the philosophy of care guiding practice at this institution.
中文翻译：
基于网络的预测家族性腺瘤性息肉病年轻患者手术时间的模型：一项内部验证的研究。
简介家族性腺瘤性息肉病（FAP）患者进行预防性结直肠手术的时机是基于结直肠癌风险的即时性。预测手术需求的能力可以帮助患者及其家人在生活事件和CRC风险的背景下进行计划。我们创建了一个模型来预测我们机构首次进行结肠镜检查后2到5年内手术的可能性。方法对所有具有有害APC突变的FAP患者询问一个单一机构的遗传性结肠直肠综合征（Cologene™）数据库。30岁以后和2000年之前进行初次结肠镜检查的患者被排除在外。进行Cox回归分析以评估与手术相关的多个因素，然后逐步进行Cox回归分析以选择最佳模型。进行接收者操作员曲线（ROC）分析以评估模型。结果共纳入211例患者（女性53％）。在平均3.8年的监视后，百分之四十五接受了手术。根据初始临床特征（年龄，性别，BMI，类胶体家族史，基因型-表型相关性），初始结肠镜检查特征（息肉数量，息肉大小，高度不典型增生）创建最终模型。以及临床事件（化学预防和息肉切除术）。AUC分别为0.87和0.84，以预测2年和5年内的手术。可以在以下网站上访问最终模型：http://app.calculoid.com/#/calculator/29638。结论该基于Web的工具可让临床医生对患者的病情进行分层。
更新日期：2018-10-17
中文翻译：
基于网络的预测家族性腺瘤性息肉病年轻患者手术时间的模型：一项内部验证的研究。
简介家族性腺瘤性息肉病（FAP）患者进行预防性结直肠手术的时机是基于结直肠癌风险的即时性。预测手术需求的能力可以帮助患者及其家人在生活事件和CRC风险的背景下进行计划。我们创建了一个模型来预测我们机构首次进行结肠镜检查后2到5年内手术的可能性。方法对所有具有有害APC突变的FAP患者询问一个单一机构的遗传性结肠直肠综合征（Cologene™）数据库。30岁以后和2000年之前进行初次结肠镜检查的患者被排除在外。进行Cox回归分析以评估与手术相关的多个因素，然后逐步进行Cox回归分析以选择最佳模型。进行接收者操作员曲线（ROC）分析以评估模型。结果共纳入211例患者（女性53％）。在平均3.8年的监视后，百分之四十五接受了手术。根据初始临床特征（年龄，性别，BMI，类胶体家族史，基因型-表型相关性），初始结肠镜检查特征（息肉数量，息肉大小，高度不典型增生）创建最终模型。以及临床事件（化学预防和息肉切除术）。AUC分别为0.87和0.84，以预测2年和5年内的手术。可以在以下网站上访问最终模型：http://app.calculoid.com/#/calculator/29638。结论该基于Web的工具可让临床医生对患者的病情进行分层。
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