Shashank Sarvepalli1, Carol A Burke1,1,1, Marc Monachese1, Rocio Lopez1,1, Brandie H Leach1,1, Lisa Laguardia1, Margaret OʼMalley1, Matthew F Kalady1,1, James M Church1,1. 1. Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. Department of Gastroenterology and Hepatology, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA. Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA. Department of Colorectal Surgery, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA. Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
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.
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.
Authors: Geneviève Michils; Sabine Tejpar; Reinhilde Thoelen; Eric van Cutsem; Joris Robert Vermeesch; Jean-Pierre Fryns; Eric Legius; Gert Matthijs Journal: Hum Mutat Date: 2005-02 Impact factor: 4.878
Authors: Patrick M Lynch; Jeffrey S Morris; Sijin Wen; Shailesh M Advani; William Ross; George J Chang; Miguel Rodriguez-Bigas; Gottumukkala S Raju; Luigi Ricciardiello; Takeo Iwama; Benedito M Rossi; Maria Pellise; Elena Stoffel; Paul E Wise; Lucio Bertario; Brian Saunders; Randall Burt; Andrea Belluzzi; Dennis Ahnen; Nagahide Matsubara; Steffen Bülow; Niels Jespersen; Susan K Clark; Steven H Erdman; Arnold J Markowitz; Inge Bernstein; Niels De Haas; Sapna Syngal; Gabriela Moeslein Journal: Gastrointest Endosc Date: 2016-01-06 Impact factor: 9.427
Authors: Shashank Sarvepalli; Carol A Burke; Marc Monachese; Brandie H Leach; Lisa Laguardia; Margaret O'Malley; Matthew F Kalady; James M Church Journal: Gastrointest Endosc Date: 2018-06-02 Impact factor: 9.427