Optimal Timing of Total Gastrectomy to Prevent Diffuse Gastric Cancer in Individuals With Pathogenic Variants in CDH1.

摘要: Background & Aims Carriers of pathogenic variants in CDH1 have a high risk hereditary diffuse gastric cancer (HDGC). Guidelines recommend prophylactic total gastrectomy (PTG) at age 20–30 years, although there is controversy over the optimal age. We developed simulation model to analyze effects PTG different ages on quality-adjusted life-years (QALYs), mortality, and life expectancy. Methods used Markov HDGC progression associated with simulate outcomes hypothetical cohorts time (ages 20–79 years). Model inputs including health state transition probabilities, mortality complication rates, quality utility values, endoscopic surveillance sensitivity were derived from publications. The primary outcome, determine strategy, was which yielded highest QALYs. Secondary unadjusted life-years. Results Our found that for men, 39 resulting 32.01 incremental QALYs, 58.81 (biologic age, 72.81 years), lifetime 8.5%. Incorporating prior decreased 6.7%, but had lower QALYs (31.59). 30 reduced 3.2%, 31.45 For women, calculated be 33.09 66.17 80.17 1.6%. Addition did not decrease women. Conclusions Using outcomes, we years men when are endpoint. These older than those current recommendations.