Princy Gupta MBBS , Peter L. Zhan MD , Ira Leeds MD , Anne Mongiu MD, PhD , Vikram Reddy MD, PhD, MBA , Haddon J. Pantel MD
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Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.</div></div><div><h3>Methods</h3><div>A retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure.</div></div><div><h3>Results</h3><div>From 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% <em>versus</em> 4.2%, <em>P</em> < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% <em>versus</em> 25%, <em>P</em> < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% <em>versus</em> 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45).</div></div><div><h3>Conclusions</h3><div>These findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 371-382"},"PeriodicalIF":1.7000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer\",\"authors\":\"Princy Gupta MBBS , Peter L. 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Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.</div></div><div><h3>Methods</h3><div>A retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure.</div></div><div><h3>Results</h3><div>From 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% <em>versus</em> 4.2%, <em>P</em> < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% <em>versus</em> 25%, <em>P</em> < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% <em>versus</em> 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45).</div></div><div><h3>Conclusions</h3><div>These findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.</div></div>\",\"PeriodicalId\":17030,\"journal\":{\"name\":\"Journal of Surgical Research\",\"volume\":\"304 \",\"pages\":\"Pages 371-382\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022480424007078\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480424007078","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
DNA错配修复（MMR）通路中的缺陷可使个体易患结直肠癌（CRC），该通路中的种系突变可导致Lynch综合征。因此，建议对所有新诊断的CRC患者进行普遍的MMR检测，以检测错配修复缺陷（MMR- d）肿瘤，从而做出明智的治疗决策。考虑到Lynch综合征患者发生异时性疾病的可能性增加，目前Lynch相关性结肠癌手术治疗指南建议对60岁以下患者延长手术切除时间。方法回顾性分析来自国家癌症数据库的非转移性结直肠癌，评估MMR-D结肠癌手术治疗的当前趋势和实践模式，并评估影响手术方式选择的因素。结果2018 - 2020年，共发现非转移性结直肠癌患者98,112例，其中MMR-D占19.93%。MMR-D结肠癌患者比错配修复熟练的肿瘤患者更有可能接受延长切除术(9.4%比4.2%,P <；0.001)。当约四分之一的MMR-D结肠癌可归因于Lynch综合征时，延长切除的频率低于预期(9.4%对25%，P <；0.001)。60岁以下的MMR-D患者比60岁以上的患者更有可能接受延长切除术（9%对3%）（优势比[OR] 3.57, 95%可信区间[CI] 3.06-4.15）。与延长切除率降低相关的因素有：未投保（OR 0.42, 95% CI 0.21-0.84）、黑人（OR 0.54, 95% CI 0.35-0.82）、在非学术中心接受治疗（OR 0.74, 95% CI 0.56-0.97）和25英里（OR 1.98, 95% CI 1.14-3.45）。结论：这些发现为MMR-D结肠癌和可能与Lynch综合征相关的结肠癌的当前手术实践模式提供了有价值的见解。
Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer
Introduction
Defects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.
Methods
A retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure.
Results
From 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% versus 4.2%, P < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% versus 25%, P < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% versus 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45).
Conclusions
These findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.
期刊介绍：
The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.
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