Rational for cancer prevention strategies in high-risk ulcerative colitis
Rational for cancer prevention strategies in high-risk ulcerative colitis
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DOI：
10.1016/s1479-666x(09)80024-3
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发表时间：
2009-04-01
影响因子：
2.5
通讯作者：
Maxwell, R. J.
中科院分区：
文献类型：
--
作者：
Campbell, F. C.;Maxwell, R. J.
结直肠癌（CRC）是溃疡性结肠炎（UC）和克罗恩结肠炎患者最担心的长期并发症。通过结肠镜检查和连续活检进行监测，以确定最有可能从潜在的治愈手术中获益的患者。在这种情况下，患有高度不典型增生或早期结直肠癌的患者通常接受结肠切除术，而没有不典型增生的患者继续接受监测计划。然而，结肠炎中不典型增生的检测可能是困难的。在明显阴性的结肠镜检查后，不充分诊断和不充分治疗的不典型增生可能伴有“间断性癌症”，阻碍了癌症预防的目标。在缺乏最佳实践模型的情况下，通过更好地了解癌症生物学，特别是炎症过程和肿瘤变化之间的密切关系，可以帮助有效预防和控制癌症的手术决策。这篇综述将总结这一领域的最新知识，并考虑疾病持续时间、严重程度和抗炎治疗对肿瘤转化的逐步事件的临床变量。在此背景下，在特定的临床情况下，监测和预防性结肠切除术的适应症将被讨论。
Colorectal cancer (CRC) is the most feared long-term complication in patients with ulcerative colitis (UC) and Crohn's colitis. Surveillance by colonoscopy and serial biopsy is conducted to identify patients most likely to benefit from potentially curative surgery. Within this paradigm, patients with high grade dysplasia or early stage CRC typically undergo colectomy, while patients free of dysplasia continue within surveillance programmes. However, detection of dysplasia in colitis may be difficult. Underdiagnosis and undertreatment of dysplasia may be accompanied by 'interval cancers' after apparently negative colonoscopy, frustrating the goal of cancer prevention. In the absence of a best practice model, surgical decisions for effective cancer prevention and control can be aided by greater understanding of cancer biology, in particular the close relationship between processes of inflammation and neoplastic change. This review will summarise recent knowledge in this area and consider clinical variables of disease duration, severity and anti-inflammatory therapy against stepwise events of neoplastic transformation. Against this background, indications for surveillance and prophylactic colectomy in specific clinical situations will be discussed.