Dataset Information

Decision-making and regret in patients with germline CDH1 variants undergoing prophylactic total gastrectomy.

ABSTRACT:

Introduction

Prophylactic total gastrectomy (PTG) can eliminate gastric cancer risk and is recommended in carriers of a germline CDH1 pathogenic variant. PTG has established risks and potential life-long morbidity. Decision-making regarding PTG is complex and not well-understood.

Methods

Individuals with germline CDH1 pathogenic or likely pathogenic variants who underwent surveillance endoscopy and recommended for PTG were evaluated. Factors associated with decision to pursue PTG (PTG^pos) or not (PTG^neg) were queried. A decision-regret survey was administered to patients who elected PTG.

Results

Decision-making was assessed in 120 patients. PTG^pos patients (63%, 76/120) were younger than PTG^neg (median 45 vs 58 years) and more often had a strong family history of gastric cancer (80.3% vs 34.1%). PTG^pos patients reported decision-making based on family history more often and decided soon after diagnosis (8 vs 27 months) compared with PTG^neg. Negative endoscopic surveillance results were more common among PTG^neg patients. Age >60 years, male sex and longer time to decision were associated with deferring PTG. Strong family history, a family member who died of gastric cancer and carcinoma on endoscopic biopsies were associated with decision to pursue PTG. In the PTG^pos group, 30 patients (43%) reported regret which was associated with occurrence of a postoperative complication and no carcinoma detected on final pathology.

Conclusion

The decision to undergo PTG is influenced by family cancer history and surveillance endoscopy results. Regret is associated with surgical complications and pathological absence of cancer. Individual cancer-risk assessment is necessary to improve pre-operative counselling and inform the decision-making process.

Trial registration number

NCT03030404.

SUBMITTER: Gamble LA

PROVIDER: S-EPMC10248794 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Decision-making and regret in patients with germline <i>CDH1</i> variants undergoing prophylactic total gastrectomy.

Gamble Lauren A LA Grant Robert R C RRC Samaranayake Sarah G SG Fasaye Grace-Ann GA Koh Christopher C Korman Louis L Asif Bilal B Heller Theo T Hernandez Jonathan M JM Blakely Andrew M AM Davis Jeremy L JL

Journal of medical genetics 20220711 3

<h4>Introduction</h4>Prophylactic total gastrectomy (PTG) can eliminate gastric cancer risk and is recommended in carriers of a germline <i>CDH1</i> pathogenic variant. PTG has established risks and potential life-long morbidity. Decision-making regarding PTG is complex and not well-understood.<h4>Methods</h4>Individuals with germline <i>CDH1</i> pathogenic or likely pathogenic variants who underwent surveillance endoscopy and recommended for PTG were evaluated. Factors associated with decision ...[more]

PMID: 35817563

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