P0475 Differential characteristics and predictors of time to colectomy in ulcerative colitis: stratified by medical refractory disease vs. colitis-associated neoplasia
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Résumé
Abstract Background Colectomy rates for ulcerative colitis (UC) have likely decreased in recent decades due to advancements in therapy, but surgery remains crucial for managing medically refractory disease or UC-associated neoplasia. This study aimed to evaluate the differential characteristics and predictors of early colectomy in UC patients undergoing colectomy for medical refractoriness versus UC-associated neoplasia. Methods We retrospectively reviewed the medical records of 569 UC patients who underwent colectomy at Mount Sinai Hospital, Toronto, between January 2010 to June 2023. Patients with pathologically confirmed UC and surgery due to medical refractoriness (MR) or UC-associated neoplasia were included. We analyzed the clinical characteristics and their impact on time to colectomy from diagnosis using Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models. Results Among the 394 patients who met the criteria, 57.1% were male, 94.7% had extensive colitis. The median ages at UC diagnosis and colectomy were 25 years (IQR 19–36) and 36 years (IQR 26-49), respectively. Of these, 288 patients (73.1%) underwent colectomy for MR, and 106 patients (26.9%) for UC-associated neoplasia. The median age at colectomy differed between the MR and neoplasia groups (33 years [IQR 24-44] vs 47 years [IQR 35-55], P < 0.001), as did the median UC duration (4 year [IQR 2-8] vs 16 years [IQR 9-21], P < 0.001). The proportion of patients with primary sclerosing cholangitis was higher in the neoplasia group (2.4% vs 20.5%, P < 0.001). The use of systemic steroids (67.7% vs 15.1%, P < 0.001) and biologics or small molecules (68.8% vs 43.4%, P < 0.001) prior to surgery was higher in the MR group. In the MR group, male sex (HR 1.30, 95% CI 1.02-1.66, P = 0.036), never smoking (HR 1.42, 95% CI 1.02-1.98, P = 0.039), and diagnosis age > 40 year (HR 1.58, 95% CI, 1.15-2.16, P = 0.005) were associated with a shorter time to colectomy. In contrast, in the neoplasia group, age at diagnosis > 40 years (HR 0.39, 95% CI 0.25–0.63, P < 0.001) was linked to a longer time to colectomy. Conclusion Significant differences in clinical characteristics were identified between UC patients undergoing colectomy for MR compared with UC-associated neoplasia. Late-onset UC, diagnosed after the age of 40, may be linked to a shorter time to colectomy for medically refractory disease while it seems to have a lower likelihood of early colectomy for neoplasia.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle