Abstract：
OBJECTIVE: Perianal fistulizing Crohn\'s disease (PFCD) is an aggressive phenotype of Crohn\'s disease defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by the TOpCLASS consortium that seeks to unify disease severity with patient-centered goals but has not yet been validated. We aimed to apply this to a real-world cohort and identify factors that predict transition between classes over time.
METHODS: We identified all patients with PFCD and at least one baseline and one follow-up pelvic (pMRI). TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs.
RESULTS: We identified 100 patients with PFCD of which 96 were assigned TOpCLASS Classes 1 - 2c at baseline. Most patients (78.1%) started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex (72.0%, 46.6%, 40.0%, p = 0.03) and prior perianal surgery (52.0% vs 44.6% vs 40.0%, p = 0.02) were more frequently observed in those with improved class. Baseline pMRI indices were not associated with changes in classification, however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modeling identified only male sex (-0.31, 95% CI -0.60 to -0.02) with improvement in class.
CONCLUSIONS: The TOpCLASS classification highlights the dynamic nature of PFCD over time, however, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.
METHODS: We identified all patients with PFCD and at least one baseline and one follow-up pelvic (pMRI). TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs.
RESULTS: We identified 100 patients with PFCD of which 96 were assigned TOpCLASS Classes 1 - 2c at baseline. Most patients (78.1%) started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex (72.0%, 46.6%, 40.0%, p = 0.03) and prior perianal surgery (52.0% vs 44.6% vs 40.0%, p = 0.02) were more frequently observed in those with improved class. Baseline pMRI indices were not associated with changes in classification, however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modeling identified only male sex (-0.31, 95% CI -0.60 to -0.02) with improvement in class.
CONCLUSIONS: The TOpCLASS classification highlights the dynamic nature of PFCD over time, however, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.
摘要：
目的：肛周瘘克罗恩病（PFCD）是克罗恩病的一种侵袭性表型，其定义为频繁复发和致残症状。TOpCLASS联盟最近概述了一种新颖的共识分类系统，该系统旨在将疾病严重程度与以患者为中心的目标统一起来，但尚未得到验证。我们的目标是将其应用于现实世界的队列，并确定预测随着时间的推移班级之间过渡的因素。
方法：我们确定了所有PFCD患者以及至少一个基线和一个盆腔随访（pMRI）。TOpCLASS分类,疾病特征，和影像学指标在与各自MRI对应的时间段进行回顾性收集.
结果：我们确定了100例PFCD患者，其中96例患者在基线时被分配到TOpCLASS1-2c级。大多数患者（78.1%）开始于2b级，但52.1%的患者出现分类变化.男性（72.0%，46.6%,40.0%,p=0.03）和先前的肛周手术（52.0%vs44.6%vs40.0%，p=0.02）在类别改善的人群中更常见。基线pMRI指标与分类变化无关，然而,MVAI的更大改进，MODIFT-CD,和PEMPAC在改善者中可见。线性混合效应模型仅识别出男性（-0.31，95％CI-0.60至-0.02），并在班级中有所改善。
结论：TOpCLASS分类突出了PFCD随时间的动态性质，然而,我们预测班级之间过渡的能力仍然有限，需要前瞻性评估。随着时间的推移，MRI指数评分的改善与向较低的TOpCLASS分类的过渡有关。
方法：我们确定了所有PFCD患者以及至少一个基线和一个盆腔随访（pMRI）。TOpCLASS分类,疾病特征，和影像学指标在与各自MRI对应的时间段进行回顾性收集.
结果：我们确定了100例PFCD患者，其中96例患者在基线时被分配到TOpCLASS1-2c级。大多数患者（78.1%）开始于2b级，但52.1%的患者出现分类变化.男性（72.0%，46.6%,40.0%,p=0.03）和先前的肛周手术（52.0%vs44.6%vs40.0%，p=0.02）在类别改善的人群中更常见。基线pMRI指标与分类变化无关，然而,MVAI的更大改进，MODIFT-CD,和PEMPAC在改善者中可见。线性混合效应模型仅识别出男性（-0.31，95％CI-0.60至-0.02），并在班级中有所改善。
结论：TOpCLASS分类突出了PFCD随时间的动态性质，然而,我们预测班级之间过渡的能力仍然有限，需要前瞻性评估。随着时间的推移，MRI指数评分的改善与向较低的TOpCLASS分类的过渡有关。
