Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis.
Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis.
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DOI：
10.1016/j.cgh.2016.11.025
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Singh S
中科院分区：
文献类型：
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作者：
Fumery M;Dulai PS;Gupta S;Prokop LJ;Ramamoorthy S;Sandborn WJ;Singh S
关于溃疡性结肠炎伴低度异型增生（UC-LGD）患者的结局知之甚少。我们评估了接受监测的UC-LGD患者队列（监测队列）中进展为结直肠癌（CRC）的发生率和风险因素，以及接受结肠切除术治疗UC-LGD患者（手术队列）中发育不良相关结果的患病率。我们对2016年6月1日进行了系统性文献综述，以确定UC-LGD成人队列研究。我们估计了监测队列中CRC的合并发病率和与异型增生进展相关的风险因素，以及手术队列中同步晚期肿瘤（CRC和/或高度异型增生）的患病率。在纳入671例UC-LGD患者（52例发生CRC）的14项监测队列研究中，CRC的合并年发病率为0. 8%（95% CI，0. 4 - 1. 3）;晚期肿瘤的合并年发病率为1. 8%（95% CI，0. 9 - 2. 7）。由专家胃肠病理学家诊断的LGD（1.5%）比由社区病理学家诊断的LGD（0.2%）发生CRC的风险更高。与异型增生进展显著相关的因素是伴随原发性硬化性胆管炎（OR，3.4; 95% CI，1.5-7.8），隐性发育不良（vs可见异型增生; OR，1.9; 95% CI，1.0-3.4），远端位置（与近端位置相比; OR，2.0; 95% CI，1.1-3.7）和多灶性发育不良（与单灶性发育不良相比; OR，3.5; 95% CI，1.5- 8.5）。在12项手术队列研究中，450例因UC-LGD接受结肠切除术的患者中，34例患者患有同步CRC（合并患病率，17%; 95%CI，8-33）。在对文献的系统回顾中，我们发现，在监测的UC-LGD患者中，进展为CRC的年发生率为0.8%; LGD诊断率的差异因病理学家的专业水平而异。伴随原发性硬化性胆管炎、不可见的异型增生、远端位置和多灶性LGD是与异型增生进展相关的高危特征。
Little is known about outcomes of patients with ulcerative colitis with low-grade dysplasia (UC-LGD). We estimated the incidence of and risk factors for progression to colorectal cancer (CRC) in cohorts of patients with UC-LGD who underwent surveillance (surveillance cohort), and the prevalence of dysplasia-related findings among patients who underwent colectomy for UC-LGD (surgical cohort). We performed a systematic literature review through June 1, 2016 to identify cohort studies of adults with UC-LGD. We estimated pooled incidence rates of CRC and risk factors associated with dysplasia progression in surveillance cohorts, and prevalence of synchronous advanced neoplasia (CRC and/or high-grade dysplasia) in surgical cohorts. In 14 surveillance cohort studies of 671 patients with UC-LGD (52 developed CRC), the pooled annual incidence of CRC was 0.8% (95% CI, 0.4–1.3); the pooled annual incidence of advanced neoplasia was 1.8% (95% CI, 0.9–2.7). Risk of CRC was higher when LGD was diagnosed by expert gastrointestinal pathologist (1.5%) than by community pathologists (0.2%). Factors significantly associated with dysplasia progression were concomitant primary sclerosing cholangitis (OR, 3.4; 95% CI, 1.5–7.8), invisible dysplasia (vs visible dysplasia; OR, 1.9; 95% CI, 1.0–3.4), distal location (vs proximal location; OR, 2.0; 95% CI, 1.1–3.7) and multifocal dysplasia (vs unifocal dysplasia; OR, 3.5; 95% CI, 1.5– 8.5). In 12 surgical cohort studies of 450 patients who underwent colectomy for UC-LGD, 34 patients had synchronous CRC (pooled prevalence, 17%; 95% CI, 8–33). In a systematic review of the literature, we found that among patients with UC-LGD under surveillance, the annual incidence of progression to CRC was 0.8%; differences in rates of LGD diagnosis varied with pathologists' level of expertise. Concomitant primary sclerosing cholangitis, invisible dysplasia, distal location, and multifocal LGD are high-risk features associated with dysplasia progression.