Metachronous Colorectal Cancer Risk for Mismatch Repair Gene Mutation Carriers: The Advantage of More Extensive Colon Surgery
Susan Parry,Susan Parry,Aung Ko Win,Bryan R. Parry,Finlay A. Macrae,Lyle C. Gurrin,James M. Church,John A. Baron,Graham G. Giles,Barbara A. Leggett,Barbara A. Leggett,Ingrid Winship,Lara Lipton,Graeme P. Young,Joanne P. Young,Joanne P. Young,Caroline J Lodge,Melissa C. Southey,Polly A. Newcomb,Loic Le Marchand,Robert W. Haile,Noralane M. Lindor,Steven Gallinger,Steven Gallinger,John L. Hopper,Mark A. Jenkins +25 more
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Patients with Lynch syndrome with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC than those receiving less extensive surgery, which will better inform decision-making about the extent of primary surgical resection.Abstract:
Background Surgical management of colon cancer for patients with Lynch syndrome who carry a mismatch repair (MMR) gene mutation is controversial. The decision to remove more or less of the colon involves the consideration of a relatively high risk of metachronous colorectal cancer (CRC) with the impact of more extensive surgery. Objective To estimate and compare the risks of metachronous CRC for patients with Lynch syndrome undergoing either segmental or extensive (subtotal or total) resection for first colon cancer. Design Risk of metachronous CRC was estimated for 382 MMR gene mutation carriers (172 MLH1 , 167 MSH2 , 23 MSH6 and 20 PMS2 ) from the Colon Cancer Family Registry, who had surgery for their first colon cancer, using retrospective cohort analysis. Age-dependent cumulative risks of metachronous CRC were calculated using the Kaplan–Meier method. Risk factors for metachronous CRC were assessed by a Cox proportional hazards regression. Results None of 50 subjects who had extensive colectomy was diagnosed with metachronous CRC (incidence rate 0.0; 95% CI 0.0 to 7.2 per 1000 person-years). Of 332 subjects who had segmental resections, 74 (22%) were diagnosed with metachronous CRC (incidence rate 23.6; 95% CI 18.8 to 29.7 per 1000 person-years). For those who had segmental resections, incidence was statistically higher than for those who had extensive surgery ( P Conclusions Patients with Lynch syndrome with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC than those receiving less extensive surgery. This finding will better inform decision-making about the extent of primary surgical resection.read more
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ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes.
Sapna Syngal,Randall E. Brand,James M. Church,Francis M. Giardiello,Heather Hampel,Randall W. Burt +5 more
TL;DR: Patients who meet clinical criteria for a syndrome as well as those with identified pathogenic germline mutations should receive appropriate surveillance measures in order to minimize their overall risk of developing syndrome-specific cancers.
Journal ArticleDOI
Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts
Hans F. A. Vasen,Ignacio Blanco,Katja Aktan-Collan,Jessica P. Gopie,Angel Alonso,Stefan Aretz,Inge Bernstein,Lucio Bertario,John Burn,Gabriel Capellá,Chrystelle Colas,Christoph Engel,Ian M. Frayling,Maurizio Genuardi,Karl Heinimann,Frederik J. Hes,Shirley Hodgson,John A. Karagiannis,Fiona Lalloo,Annika Lindblom,Jukka-Pekka Mecklin,Pål Møller,Torben Myrhøj,Fokko M. Nagengast,Yann Parc,Maurizio Ponz de Leon,Laura Renkonen-Sinisalo,Julian R. Sampson,Astrid Stormorken,Rolf H. Sijmons,Sabine Tejpar,Huw Thomas,Nils Rahner,Juul T. Wijnen,Heikki Järvinen,Gabriela Möslein +35 more
TL;DR: The guidelines described in this paper may be helpful for the appropriate management of families with LS and Prospective controlled studies should be undertaken to improve further the care of these families.
Journal ArticleDOI
Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
Francis M. Giardiello,John I. Allen,Jennifer E. Axilbund,C. Richard Boland,Carol A. Burke,Randall W. Burt,James M. Church,Jason A. Dominitz,David A. Johnson,Tonya Kaltenbach,Theodore R. Levin,David A. Lieberman,Douglas J. Robertson,Douglas J. Robertson,Sapna Syngal,Sapna Syngal,Douglas K. Rex +16 more
TL;DR: The Multi-Society Task Force developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome.
Journal ArticleDOI
Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
Francis M. Giardiello,John I. Allen,Jennifer E. Axilbund,C. Richard Boland,Carol A. Burke,Randall W. Burt,James M. Church,Jason A. Dominitz,David A. Johnson,Tonya Kaltenbach,Theodore R. Levin,David A. Lieberman,Douglas J. Robertson,Sapna Syngal,Douglas K. Rex +14 more
TL;DR: The Multi-Society Task Force developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome.
References
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AJCC Cancer Staging Manual
Mahul B. Amin,Stephen B. Edge,Frederick L. Greene,David R. Byrd,Robert K. Brookland,Mary Kay Washington,Jeffrey E. Gershenwald,Carolyn C. Compton,Kenneth R. Hess,Daniel C. Sullivan,J. Milburn Jessup,James D. Brierley,Lauri E. Gaspar,Richard L. Schilsky,Charles M. Balch,David P. Winchester,Elliot A. Asare,Martin Madera,Donna M. Gress,Laura R. Meyer +19 more
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Posted Content
Regression standard errors in clustered samples
TL;DR: In this paper, the residuals are sorted and the observation is located in the residual corresponding to the quantile in question, taking into account weights if they are applied, and the square root of the sum of the weights is calculated.
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A Note on Robust Variance Estimation for Cluster‐Correlated Data
TL;DR: This brief note presents a general proof that the estimator is unbiased for cluster-correlated data regardless of the setting.
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New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative group on HNPCC.
TL;DR: The establishment of a set of selection criteria for families with hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) to provide a basis for uniformity in collaborative studies and a definition of HNPCC was proposed that was aimed at helping clinicians to identify families.
Journal ArticleDOI
Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer
Heikki Järvinen,Markku Aarnio,Harri Mustonen,Katja Aktan–Collan‡,Lauri A. Aaltonen,Päivi Peltomäki,Albert de la Chapelle,Jukka-Pekka Mecklin +7 more
TL;DR: Colonic screening at 3-year intervals more than halves the risk of CRC, prevents CRC deaths, and decreases overall mortality by about 65% in HNPCC families.
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