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Artificial Intelligence in Clinical Decision-Making: Is It Problem Free? 临床决策中的人工智能:没有问题吗?
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-07 DOI: 10.1097/DCR.0000000000003636
Mesut Tez
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引用次数: 0
Corrigendum.
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-07 DOI: 10.1097/DCR.0000000000003640
Donald B Colvin, Kelly M Tyler
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引用次数: 0
Oligometastatic Disease Is Not an Absolute Contraindication to Pelvic Exenteration in Selected Patients With Locally Recurrent Rectal Cancer. 少数转移性疾病并非局部复发直肠癌患者盆腔切除术的绝对禁忌症。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-27 DOI: 10.1097/DCR.0000000000003613
Jennifer K Vu, Kilian G M Brown, Michael J Solomon, Kheng-Seong Ng, Kate Mahon, Bernard K Le, Sarah Sutherland, Peter J Lee, Christopher M Byrne, Kirk K S Austin, Daniel Steffens
<p><strong>Background: </strong>The treatment of locally recurrent rectal cancer has evolved dramatically in recent decades. As the boundaries of exenterative surgery continue to be pushed, one of the unanswered and controversial questions is the role of radical salvage surgery for locally recurrent rectal cancer in the setting of oligometastatic disease.</p><p><strong>Objective: </strong>To investigate the impact of synchronous or previously treated distant metastases on survival after pelvic exenteration for locally recurrent rectal cancer.</p><p><strong>Design: </strong>Retrospective analysis of a prospectively maintained database.</p><p><strong>Settings: </strong>A high-volume specialist exenteration center.</p><p><strong>Patients: </strong>Consecutive adult patients undergoing pelvic exenteration with curative intent for locally recurrent rectal cancer between 1994 and 2023.</p><p><strong>Main outcome measures: </strong>Overall survival from time of pelvic exenteration.</p><p><strong>Results: </strong>Of the 300 patients included, 193 (64%) were men, and the median age at the time of pelvic exenteration was 62 years (range, 29-86). The median time from primary rectal cancer surgery to pelvic exenteration was 35 months (range, 4-191). In total, 56 patients (19%) had a history of metastatic disease, of whom 42 (14%) had previously treated metastases and 18 patients (6%) had synchronous metastatic disease (including 4 patients with both synchronous and previously treated metastases). Five-year overall survival rate and median overall survival was 41% and 45 months, respectively. There was a trend toward poorer 5-year overall survival in patients with a history of metastatic disease compared to those without (25% vs 45%); however, this did not reach statistical significance ( p = 0.110), possibly due to a lack of statistical power. Five-year overall survival was 27%, 25%, and 45% for patients with synchronous metastases, previously treated metastases, and no history of metastases, respectively ( p = 0.260).</p><p><strong>Limitations: </strong>Findings may not be applicable beyond highly selected patients treated at specialized exenteration centers.</p><p><strong>Conclusions: </strong>Long-term survival is achievable in highly selected patients with locally recurrent rectal cancer and synchronous or previously treated distant metastases. Therefore, oligometastatic disease should not be considered an absolute contraindication to exenterative surgery. See Video Abstract .</p><p><strong>La enfermedad oligometastsica no es una contraindicacin absoluta para la exenteracin plvica en pacientes seleccionados con cncer rectal localmente recurrente: </strong>ANTECEDENTES:El tratamiento del cáncer rectal localmente recurrente ha evolucionado drásticamente en las últimas décadas. A medida que se siguen ampliando los límites de la cirugía exenterativa, una de las preguntas sin respuesta y controvertidas es el papel de la cirugía radical de rescate para el cán
背景:近几十年来,局部复发性直肠癌的治疗发生了巨大的变化。随着切除手术的界限不断被推进,其中一个悬而未决的和有争议的问题是根治性挽救性手术治疗局部复发直肠癌在低转移性疾病中的作用。目的:探讨同步或既往治疗过的远处转移对局部复发直肠癌盆腔切除术后生存率的影响。设计:对前瞻性维护数据库进行回顾性分析。设置:一个高容量的专家切除中心。患者:1994年至2023年间连续接受盆腔切除术治疗局部复发性直肠癌的成年患者。主要观察指标:盆腔切除后的总生存率。结果:纳入的300例患者中,男性193例(64%),中位年龄62岁(29-86岁)。从原发性直肠癌手术到盆腔切除的中位时间为35个月(范围4-191)。总共56例患者(19%)有转移性疾病史;其中42例(14%)曾接受过转移治疗,18例(6%)患有同步转移性疾病(包括4例同时接受过转移治疗和同步转移的患者)。5年和中位总生存期分别为41%和45个月。与无转移病史的患者相比,有转移病史患者的5年总生存率有较差的趋势(25% vs 45%);然而,这并没有达到统计学意义(p = 0.110),可能是由于缺乏统计能力。同步转移患者、既往治疗过的转移患者和无转移史患者的5年总生存率分别为27%、25%和45% (p = 0.260)。局限性:研究结果可能不适用于在专业拔牙中心治疗的高度选定的患者。结论:高度选择性的局部复发直肠癌和同步或既往治疗过的远处转移患者可以实现长期生存。因此,少转移性疾病不应被视为绝对禁忌症。参见视频摘要。
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引用次数: 0
Selected Abstracts.
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-27 DOI: 10.1097/DCR.0000000000003625
Irena Gribovskaja-Rupp, Samuel Eisenstein, Carla F Justiniano, Shankar Raman, V Prasad Poola
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引用次数: 0
Rise in Minimally Invasive Surgery for Colorectal Cancer Is Associated With Adoption of Robotic Surgery. 结直肠癌微创手术的增加与机器人手术的采用有关。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-02 DOI: 10.1097/DCR.0000000000003617
Naveen Manisundaram, Christopher P Childers, Chung-Yuan Hu, Abhineet Uppal, Tsuyoshi Konishi, Brian K Bednarski, Michael G White, Oliver Peacock, Y Nancy You, George J Chang
<p><strong>Background: </strong>Minimally invasive surgery is associated with improved short-term outcomes and similar long-term oncologic outcomes for patients with colorectal cancer compared with open surgery. Although the robotic approach has ergonomic and technical benefits, how it has impacted the utilization of traditional laparoscopic surgery and minimally invasive surgery overall is unclear.</p><p><strong>Objective: </strong>Describe trends in open, robotic, and laparoscopic approaches for colorectal cancer resections and examine factors associated with minimally invasive surgery.</p><p><strong>Design: </strong>Retrospective cohort study using data from the National Cancer Database from 2010 to 2020.</p><p><strong>Setting: </strong>Commission on Cancer-accredited US facilities.</p><p><strong>Patients: </strong>Patients diagnosed with nonmetastatic colon or rectal adenocarcinoma.</p><p><strong>Main outcome measures: </strong>Surgical approach rates (open, robotic, and laparoscopic).</p><p><strong>Results: </strong>We identified 475,001 patients diagnosed with nonmetastatic colorectal adenocarcinoma, of whom 192,237 (40.5%) underwent open surgery, 64,945 (13.7%) underwent robotic surgery, and 217,819 (45.9%) underwent laparoscopic surgery. For colon cancer, laparoscopic minimally invasive surgery use steadily increased, with a peak prevalence of 54.0% in 2016, and total minimally invasive surgery (robotic + laparoscopic) was performed more often than open surgery from 2013 through 2020. For rectal cancer, laparoscopic minimally invasive surgery had a peak prevalence of 37.2% in 2014 and declined from 2014 through 2020; robotic surgery prevalence increased throughout the study period (5.5% in 2010, 24.7% in 2015, and 48.8% in 2020). Minimally invasive surgery use increased in facilities performing robotic surgery every year during the study period. For both colon and rectal cancer, the use of open surgery decreased across all facilities throughout the study period.</p><p><strong>Limitations: </strong>This study used the National Cancer Database, which may not be generalizable to non-Commission on Cancer institutions.</p><p><strong>Conclusions: </strong>Minimally invasive surgery steadily increased across all facilities from 2010 through 2020. Open resections declined, laparoscopic resections plateaued, and robotic resections increased for colon and rectal cancer. Minimally invasive surgery increases may be driven by increases in robot-assisted surgery. See Video Abstract.</p><p><strong>El aumento de la ciruga mnimamente invasiva para el cncer colorrectal se asocia con la adopcin a la ciruga robtica: </strong>ANTECEDENTES:La cirugía mínimamente invasiva se asocia con mejores resultados a corto plazo y resultados oncológicos similares a largo plazo para pacientes con cáncer colorrectal en comparación con la cirugía abierta. Aunque el abordaje robótico tiene beneficios ergonómicos y técnicos, no está claro cómo ha afectado la utilización de la
背景:与开放手术相比,微创手术可改善结直肠癌患者的短期预后和相似的长期肿瘤预后。尽管机器人方法具有人体工程学和技术上的优势,但它如何影响传统腹腔镜手术和微创手术的总体应用尚不清楚。目的:描述开放、机器人和腹腔镜入路在结直肠癌切除术中的发展趋势,并探讨微创手术的相关因素。设计:回顾性队列研究,使用2010年至2020年国家癌症数据库的数据。环境:美国癌症委员会认可的设施。患者:诊断为非转移性结肠或直肠腺癌的患者。主要观察指标:手术入路率(开放、机器人、腹腔镜)。结果:我们确定了475,001例确诊为非转移性结直肠腺癌的患者,其中192,237例(40.5%)接受了开放手术,64,945例(13.7%)接受了机器人手术,217,819例(45.9%)接受了腹腔镜手术。对于结肠癌,腹腔镜微创手术的使用稳步增加,2016年达到54.0%的峰值,2013 - 2020年,全微创手术(机器人+腹腔镜)的使用频率高于开放手术。对于直肠癌,腹腔镜微创手术的患病率在2014年达到37.2%的峰值,从2014年到2020年呈下降趋势;在整个研究期间,机器人手术的患病率有所上升(2010年为5.5%,2015年为24.7%,2020年为48.8%)。在研究期间,微创手术的使用在每年进行机器人手术的机构中都有所增加。对于结肠癌和直肠癌,在整个研究期间,所有机构的开放式手术的使用都有所减少。局限性:使用的国家癌症数据库可能无法推广到非癌症委员会机构。结论:从2010年到2020年,所有医院的微创手术稳步增加。对于结肠癌和直肠癌,开放式手术减少,腹腔镜手术趋于平稳,机器人手术增加。微创手术的增加可能是由于机器人辅助手术的增加。参见视频摘要。
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引用次数: 0
TNMF Vs TNM in Staging of Colorectal Cancer.
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2024-11-13 DOI: 10.1097/DCR.0000000000003603
Ahmed Farag, Mohamed Yehia Elbarmalgi
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引用次数: 0
3-Dimensional Pouchography: A Video Tutorial. 三维摄影:视频教程。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-10 DOI: 10.1097/DCR.0000000000003505
Stefan D Holubar
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引用次数: 0
Rectal Cancer Surgery Can Be Tailored to Reduce Morbidity. 直肠癌手术可以量身定制以降低发病率。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-07 DOI: 10.1097/DCR.0000000000003638
Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer M Park
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引用次数: 0
Pilot Feasibility Study of Physical Activity to Manage Bowel Dysfunction in Survivors of Rectal Cancer. 体育活动治疗直肠癌幸存者肠功能障碍的试点可行性研究。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-23 DOI: 10.1097/DCR.0000000000003583
Ariel Nehemiah, Erica N Pettke, Scott Appel, David O Garcia, Jennifer W Bea, Cynthia A Thomson, Virginia Sun, Robert S Krouse
<p><strong>Background: </strong>Low anterior resection syndrome can disrupt health-related quality of life for survivors of rectal cancer.</p><p><strong>Objective: </strong>To assess the feasibility, satisfaction with, and benefit of a pilot telehealth physical activity counseling intervention for survivors of rectal cancer with low anterior resection syndrome.</p><p><strong>Design: </strong>Single-site, single-arm prospective pre-postintervention pilot feasibility study.</p><p><strong>Settings: </strong>This study was conducted at a single academic institution via telehealth.</p><p><strong>Patients: </strong>Patients with stage I to III rectal or rectosigmoid cancer and low anterior resection syndrome who were 3 months to 5 years post-low anterior resection alone or with diverting loop ileostomy and subsequent reversal were included.</p><p><strong>Interventionss: </strong>Twenty-four patients completed 12 weekly one-to-one physical activity counseling sessions with a health coach.</p><p><strong>Main outcome measures: </strong>Feasibility, participant satisfaction, low anterior resection syndrome score, Memorial Sloan Kettering Cancer Center Bowel Function Instrument, International Physical Activity Questionnaire, City of Hope Quality of Life Survey-Colorectal Cancer, and daily step counts.</p><p><strong>Results: </strong>Twenty-seven patients enrolled in the study and 24 (89%) completed the intervention. Every intervention participant attended all telehealth coaching sessions. Through exit interviews, participants expressed satisfaction with the study, said it positively impacted their mental health, and said it helped them cope with their symptoms. At 12 weeks, bowel function improved by 7.27% ( p = 0.002) and 16.5% ( p ≤ 0.0001) as measured by the bowel function instrument and low anterior resection syndrome score, respectively. Quality of life improved by 9.8% at 12 weeks ( p = 0.009), with the social domain having the greatest improvement (22%, p < 0.0001). These improvements persisted at a 12-week follow-up. Daily steps increased by 17.5% during the intervention ( p = 0.035).</p><p><strong>Limitations: </strong>Pre-postintervention study design.</p><p><strong>Conclusions: </strong>Delivering a telehealth counseling intervention is feasible and satisfactory for survivors of rectal cancer with low anterior resection syndrome. This intervention has positive implications for bowel health and health-related quality of life. See Video Abstract .</p><p><strong>Trial registration: </strong>NCT06435975.</p><p><strong>Estudio piloto de viabilidad de la actividad fsica para el tratamiento de la disfuncin intestinal en sobrevivientes de cncer de recto: </strong>ANTECEDENTES:El síndrome de resección anterior baja (LARS, por sus siglas en inglés) puede afectar la calidad de vida relacionada con la salud de los sobrevivientes de cáncer rectal.OBJETIVO:Evaluar la viabilidad, la satisfacción y el beneficio de una intervención piloto de asesoramiento sobre a
背景:低位前切除术综合征可破坏直肠癌幸存者的健康相关生活质量。目的:评价远程健康体育活动咨询干预直肠癌低前切除综合征幸存者的可行性、满意度和效果。设计:单场地,单臂前瞻性试验前后可行性干预。环境:本研究通过远程医疗在单一学术机构进行。患者:包括I-III期直肠或直肠乙状结肠癌合并低位前切除术综合征的患者,在单独低位前切除术后3个月至5年,或进行回肠袢转流造口并随后逆转。干预:24名患者在健康教练的指导下完成了12周一对一的身体活动咨询课程。主要观察指标:可行性、参与者满意度、低前切除术综合征评分、纪念斯隆凯特琳癌症中心肠功能仪、国际体育活动问卷、希望之城生活质量调查-结直肠癌、每日步数。结果:27例患者入组,24例(89%)完成干预。每位干预参与者都参加了所有远程保健辅导课程。通过离职面谈,参与者表达了对研究的满意,并表示研究对他们的心理健康产生了积极影响,并帮助他们应对症状。在12周时,肠道功能改善7.27% (p = 0.002)和16.5% (p≤0.0001),分别由肠功能仪和低前切除术综合征评分测量。12周时生活质量提高了9.8% (p = 0.009),其中社会领域的改善最大(22%,p < 0.0001)。这些改善在12周的随访中持续存在。干预期间每日步数增加17.5% (p = 0.035)。局限性:研究前后设计。结论:对直肠癌LARS幸存者进行远程健康咨询干预是可行且令人满意的。这种干预对肠道健康和与健康相关的生活质量有积极的影响。参见视频摘要。临床试验注册:NCT06435975。
{"title":"Pilot Feasibility Study of Physical Activity to Manage Bowel Dysfunction in Survivors of Rectal Cancer.","authors":"Ariel Nehemiah, Erica N Pettke, Scott Appel, David O Garcia, Jennifer W Bea, Cynthia A Thomson, Virginia Sun, Robert S Krouse","doi":"10.1097/DCR.0000000000003583","DOIUrl":"10.1097/DCR.0000000000003583","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low anterior resection syndrome can disrupt health-related quality of life for survivors of rectal cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the feasibility, satisfaction with, and benefit of a pilot telehealth physical activity counseling intervention for survivors of rectal cancer with low anterior resection syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Single-site, single-arm prospective pre-postintervention pilot feasibility study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;This study was conducted at a single academic institution via telehealth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients with stage I to III rectal or rectosigmoid cancer and low anterior resection syndrome who were 3 months to 5 years post-low anterior resection alone or with diverting loop ileostomy and subsequent reversal were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventionss: &lt;/strong&gt;Twenty-four patients completed 12 weekly one-to-one physical activity counseling sessions with a health coach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Feasibility, participant satisfaction, low anterior resection syndrome score, Memorial Sloan Kettering Cancer Center Bowel Function Instrument, International Physical Activity Questionnaire, City of Hope Quality of Life Survey-Colorectal Cancer, and daily step counts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-seven patients enrolled in the study and 24 (89%) completed the intervention. Every intervention participant attended all telehealth coaching sessions. Through exit interviews, participants expressed satisfaction with the study, said it positively impacted their mental health, and said it helped them cope with their symptoms. At 12 weeks, bowel function improved by 7.27% ( p = 0.002) and 16.5% ( p ≤ 0.0001) as measured by the bowel function instrument and low anterior resection syndrome score, respectively. Quality of life improved by 9.8% at 12 weeks ( p = 0.009), with the social domain having the greatest improvement (22%, p &lt; 0.0001). These improvements persisted at a 12-week follow-up. Daily steps increased by 17.5% during the intervention ( p = 0.035).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Pre-postintervention study design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Delivering a telehealth counseling intervention is feasible and satisfactory for survivors of rectal cancer with low anterior resection syndrome. This intervention has positive implications for bowel health and health-related quality of life. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;NCT06435975.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Estudio piloto de viabilidad de la actividad fsica para el tratamiento de la disfuncin intestinal en sobrevivientes de cncer de recto: &lt;/strong&gt;ANTECEDENTES:El síndrome de resección anterior baja (LARS, por sus siglas en inglés) puede afectar la calidad de vida relacionada con la salud de los sobrevivientes de cáncer rectal.OBJETIVO:Evaluar la viabilidad, la satisfacción y el beneficio de una intervención piloto de asesoramiento sobre a","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"483-490"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
National Analysis of More Than 48,000 Veterans With HIV Demonstrates CD4/CD8 Ratio as a Risk Marker for Anal Intraepithelial Lesions and Anal Cancer. 对48000多名感染HIV的退伍军人的全国分析表明,CD4/CD8比值是肛门上皮内病变和肛门癌的风险标志。
IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-02 DOI: 10.1097/DCR.0000000000003611
Austin J Hewitt, Matthew J Freeman, Glen E Leverson, Howard H Bailey, Evie H Carchman, Rob Striker, Cristina B Sanger
<p><strong>Background: </strong>Anal squamous intraepithelial lesions are identifiable and treatable precancerous lesions that lack defined risk factors determining screening necessity.</p><p><strong>Objective: </strong>Assess the prevalence and risk factors associated with low- and high-grade anal squamous intraepithelial lesions and anal squamous-cell carcinoma.</p><p><strong>Design: </strong>Retrospective cohort analysis of veterans with HIV between 1999 and 2023.</p><p><strong>Settings: </strong>National multicenter study of the Department of Veterans Affairs.</p><p><strong>Patients: </strong>Veterans with HIV who had >1 year of follow-up and no anal squamous intraepithelial lesions or anal cancer diagnosis before the study period.</p><p><strong>Main outcome measures: </strong>Primary outcomes include the prevalence, disease-free survival rates, and HRs associated with risk factors for developing anal squamous intraepithelial lesions and/or anal cancer.</p><p><strong>Results: </strong>A total of 48,368 patients were analyzed. The mean age of patients at study initiation was 47.8 years, with a mean follow-up of 12.3 years. Seven thousand five hundred seventy-two patients (16%) had at least 1 anal cytopathology or histopathology result. The prevalence of anal disease was recorded for low-grade disease (n = 1513; 3.1%), high-grade disease (n = 1484; 3.1%), and cancer (n = 664; 1.4%). Mean (SD) times to first incident low-grade disease, high-grade disease, and cancer were 8.5 (6.0), 9.1 (6.0), and 9.7 (6.2) years, respectively. Five-year, 10-year, and 20-year disease-free survival rates for the development of low-grade disease, high-grade disease, or cancer were 97.5%, 94.5%, and 88.4%, respectively. Cox regression modeling demonstrated that CD4/CD8 ratios of <0.5 were associated with an increased risk of anal cancer (HR, 3.93; 95% CI, 3.33-4.63; p < 0.001).</p><p><strong>Limitations: </strong>Retrospective study that focused almost exclusively on male US veterans. Results might not apply to non-male, non-US populations.</p><p><strong>Conclusions: </strong>National analysis of more than 48,000 veterans with HIV demonstrates that 16% had anal cytopathology or histopathology results with an anal cancer prevalence of 1.4%. CD4/CD8 ratios of <0.5 correlate strongly with the severity of anal disease and can help identify patients at the highest risk for anal cancer to prioritize screening efforts. See Video Abstract.</p><p><strong>Anlisis nacional de ms de veteranos con vih demuestra que la relacin cd/cd es un marcador de riesgo de lesiones intraepiteliales anales y cncer anal: </strong>ANTECEDENTES:Las lesiones intraepiteliales escamosas anales son lesiones precancerosas identificables y tratables que carecen de factores de riesgo definidos que determinen la necesidad de detección.OBJETIVO:Evaluar la prevalencia y los factores de riesgo asociados con las lesiones intraepiteliales escamosas anales de grado bajo y alto y el carcinoma de células escamos
背景:肛门鳞状上皮内病变是可识别和可治疗的癌前病变,缺乏确定的危险因素决定筛查的必要性。目的:评估低级别和高级别肛门鳞状上皮内病变和肛门鳞状细胞癌的患病率和相关危险因素。设计:对1999-2023年感染HIV的退伍军人进行回顾性队列分析。背景:退伍军人事务部的国家多中心研究。患者:感染HIV的退伍军人,随访10 ~ 10年,研究前无肛门鳞状上皮内病变或肛门癌诊断。主要结局和测量:主要结局包括患病率、无病生存率和与发生肛门鳞状上皮内病变和/或肛门癌的危险因素相关的风险比。结果:共分析48368例患者。研究开始时患者的平均年龄为47.8岁,平均随访时间为12.3年。7572例(16%)患者至少有一项肛门细胞病理学或组织病理学结果。肛门疾病的患病率记录为低级别疾病(n = 1,513, 3.1%),高级别疾病(n = 1,484, 3.1%)和癌症(n = 664, 1.4%)。首次发生低级别疾病、高级别疾病和癌症的平均时间分别为8.5 (SD = 6.0)、9.1 (SD = 6.0)和9.7 (SD = 6.2)年。低级别疾病、高级别疾病或癌症的5年、10年和20年无病生存率分别为97.5%、94.5%和88.4%。Cox回归模型显示CD4/CD8比值局限性:回顾性研究几乎只关注美国男性退伍军人。结果可能不适用于非男性,非美国。人群。结论:对48,000多名感染艾滋病毒的退伍军人的全国分析显示,16%的人有肛门细胞病理学或组织病理学结果,肛门癌患病率为1.4%。CD4 / CD8比值
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引用次数: 0
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Diseases of the Colon & Rectum
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