Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

被引：71

作者：

Cavestro, Giulia Martina ^{[1
]}

Mannucci, Alessandro ^{[1
]}

Balaguer, Francesc ^{[2
,3
]}

Hampel, Heather ^{[4
]}

Kupfer, Sonia S. ^{[5
]}

Repici, Alessandro ^{[6
]}

Sartore-Bianchi, Andrea ^{[7
,8
]}

Seppala, Toni T. ^{[9
,10
,11
,12
,13
,14
]}

Valentini, Vincenzo ^{[15
]}

Boland, Clement Richard ^{[16
]}

Brand, Randall E. ^{[17
]}

Buffart, Tineke E. ^{[18
]}

Burke, Carol A. ^{[19
]}

Caccialanza, Riccardo ^{[20
]}

Cannizzaro, Renato ^{[21
]}

Cascinu, Stefano ^{[22
]}

Cercek, Andrea ^{[23
]}

Crosbie, Emma J. ^{[24
,25
]}

Danese, Silvio ^{[1
]}

Dekker, Evelien ^{[26
]}

Daca-Alvarez, Maria ^{[2
]}

Deni, Francesco ^{[27
]}

Dominguez-Valentin, Mev ^{[28
]}

Eng, Cathy ^{[29
]}

Goel, Ajay ^{[30
]}

Guillem, Jose G. ^{[31
,32
]}

Houwen, Britt B. S. L. ^{[26
]}

Kahi, Charles ^{[33
]}

Kalady, Matthew F. ^{[34
]}

Kastrinos, Fay ^{[35
,36
]}

Kuehn, Florian ^{[37
]}

Laghi, Luigi ^{[38
,39
]}

Latchford, Andrew ^{[40
]}

Liska, David ^{[41
,42
]}

Lynch, Patrick ^{[43
]}

Malesci, Alberto ^{[1
]}

Mauri, Gianluca ^{[7
,8
,44
]}

Meldolesi, Elisa ^{[15
]}

Moller, Pal ^{[28
]}

Monahan, Kevin J. ^{[40
,45
]}

Moeslein, Gabriela ^{[46
]}

Murphy, Caitlin C. ^{[47
]}

Nass, Karlijn ^{[26
]}

Ng, Kimmie ^{[48
]}

Oliani, Cristina ^{[49
]}

Papaleo, Enrico ^{[50
]}

Patel, Swati G. ^{[51
,52
]}

Puzzono, Marta ^{[1
]}

Remo, Andrea ^{[53
]}

Ricciardiello, Luigi ^{[54
]}

机构：

[1] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Gastroenterol & Gastrointestinal Endoscopy Unit, Milan, Italy

[2] Hosp Clin Barcelona, IDIBAPS, Dept Gastroenterol, Barcelona, Spain

[3] Univ Barcelona, CIBERehd, Barcelona, Spain

[4] City Hope Natl Med Ctr, Dept Med Oncol & Therapeut Res, Duarte, CA 91010 USA

[5] Univ Chicago Med, Sect Gastroenterol Hepatol & Nutr, Dept Med, Chicago, IL USA

[6] Humanitas Univ, Humanitas Res Hosp, Gastrointestinal Endoscopy Unit, Rozzano, Italy

[7] Univ Milan, Dept Oncol & Hematooncol, Milan, Italy

[8] Grande Osped Metropolitano Niguarda, Dept Hematol Oncol & Mol Med, Milan, Italy

[9] Univ Tampere, Fac Med & Med Technol, Tampere, Finland

[10] TAYS Canc Ctr, Tampere, Finland

[11] Tampere Univ Hosp, Unit Gastroenterol Surg, Tampere, Finland

[12] Univ Helsinki, Appl Tumor Genom Res Program, Helsinki, Finland

[13] Univ Helsinki, Dept Surg, Helsinki, Finland

[14] Helsinki Univ Hosp, Helsinki, Finland

[15] Univ Cattolica Sacro Cuore Roma, Dept Radiol Radiat Oncol & Hematol, Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy

[16] Univ Calif San Diego, Dept Med, Div Gastroenterol, San Diego, CA 92103 USA

[17] Univ Pittsburgh, Div Gastroenterol Hepatol & Nutr, Pittsburgh, PA USA

[18] Amsterdam UMC, Dept Med Oncol, Locat Boelelaan, Amsterdam, Netherlands

[19] Cleveland Clin, Dept Gastroenterol Hepatol & Nutr, Cleveland, OH 44106 USA

[20] Fdn IRCCS Policlin San Matteo, Clin Nutr & Dietet Unit, Pavia, Italy

[21] IRCCS 33081, SOC Gastroenterol Oncol & Sperimentale, Ctr Riferimento Oncol Aviano CRO, Aviano, Italy

[22] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Oncol Dept, Milan, Italy

[23] Mem Sloan Kettering Canc Ctr, Dept Med, 1275 York Ave, New York, NY 10021 USA

[24] Univ Manchester, Fac Biol Med & Hlth, Div Canc Sci, St Marys Hosp, Manchester, Lancs, England

[25] Manchester Univ NHS Fdn Trust, Manchester Acad Hlth Sci Ctr, St Marys Hosp, Div Gynaecol, Manchester, Lancs, England

[26] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[27] IRCCS San Raffaele Sci Inst, Dept Anesthesia & Intens Care, Milan, Italy

[28] Norwegian Radium Hosp, Inst Canc Res, Dept Tumor Biol, Oslo, Norway

[29] Vanderbilt Ingram Canc Ctr, Div Hematol & Oncol, Dept Med, Nashville, TN USA

[30] City Hope Comprehens Canc Ctr, Beckman Res Inst, Dept Mol Diagnost & Expt Therapeut, Duarte, CA USA

[31] Univ North Carolina, Dept Surg, Chapel Hill, NC 27515 USA

[32] Univ North Carolina, Lineberger Canc Ctr, Chapel Hill, NC 27515 USA

[33] Indiana Univ Sch Med, Div Gastroenterol & Hepatol, Dept Med, Indianapolis, IN 46202 USA

[34] Ohio State Univ, Dept Surg, Wexner Med Ctr, Columbus, OH 43210 USA

[35] Columbia Univ, Irving Med Ctr, Herbert Irving Comprehens Canc Ctr, Div Digest & Liver Dis, New York, NY USA

[36] Vagelos Coll Phys & Surg, New York, NY USA

[37] Ludwig Maximilians Univ Munchen, Dept Gen Visceral & Transplant Surg, Munich, Germany

[38] Univ Parma, Dept Med & Surg, Parma, Italy

[39] IRCCS Humanitas Res Hosp, Lab Mol Gastroenterol, Rozzano Milan, Italy

[40] London North West Univ Healthcare NHS Trust, St Marks Hosp, Ctr Familial Intestinal Canc, Lynch Syndrome Clin, Harrow, Middx, England

[41] Cleveland Clin, Dept Colorectal Surg, Cleveland, OH 44106 USA

[42] Cleveland Clin, Edward J DeBartolo Jr Family Ctr Young Onset Colo, Digest Dis & Surg Inst, Cleveland, OH 44106 USA

[43] Univ Texas MD Anderson Canc Ctr, Dept Gastroenterol, Houston, TX 77030 USA

[44] IFOM ETS AIRC Inst Mol Oncol, Milan, Italy

[45] Imperial Coll, Dept Surg & Canc, Fac Med, London, England

[46] Acad Hosp Univ Dusseldorf, Ev BETHESDA Khs Duisburg, Surg Ctr Hereditary Tumors, Dusseldorf, Germany

[47] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Houston, TX 77030 USA

[48] Harvard Med Sch, Dana Farber Canc Inst, Young Onset Colorectal Canc Ctr, Boston, MA 02115 USA

[49] Santa Maria Della Misericordia Hosp, AULSS Polesana 5, Med Oncol, Rovigo, Italy

[50] IRCCS San Raffaele Sci Inst, Dept Obstet & Gynecol, Ctr Sci Natalita, Milan, Italy

来源：

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY | 2023年 / 21卷 / 03期

关键词：

Recommendation; Clinical; Young; 50; Years; Colorectal Cancer; SOCIETY-TASK-FORCE; FECAL IMMUNOCHEMICAL TEST; SUSCEPTIBILITY GENE-MUTATIONS; CLINICAL-PRACTICE GUIDELINES; DISEASE-FREE SURVIVAL; RECTAL-CANCER; YOUNG-ADULTS; COLONOSCOPY SURVEILLANCE; COLON-CANCER; RISK-FACTORS;

D O I：

10.1016/j.cgh.2022.12.006

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. METHODS: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of >= 80%. RESULTS: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. CONCLUSIONS: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC.

引用

页码：581 / +

页数：56

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