Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: A cohort study
Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: A cohort study
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DOI：
10.1053/j.gastro.2007.08.001
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发表时间：
2007-10-01
期刊：
影响因子：
29.4
通讯作者：
Ullman, Thomas
中科院分区：
文献类型：
--
作者：
Gupta, Roopali Bansal;Harpaz, Noam;Ullman, Thomas
背景和目标：虽然炎症被认为是溃疡性结肠炎（UC）结肠肿瘤的原因，但很少有研究直接研究这种关系。我们的目的是确定随着时间的推移，显微镜下炎症的严重程度是否是UC肿瘤进展的独立危险因素。方法：研究一组定期接受内镜监测的UC患者的异型增生。作为常规临床护理的一部分，使用高度可重复的组织学活动指数对每个活检部位的炎症程度进行分级。在比例风险模型中分析肿瘤进展，炎症以3种不同方式总结，每种方式均作为随时间变化的协变量：（1）平均炎症评分（IS-平均值），（2）二元炎症评分（IS-箱）和（3）最大炎症评分（IS-最大值）。在单变量检验中分析潜在的混杂因素，当显著时，在多变量模型中分析。结果如下：在418例符合入选标准的患者中，15例进展为晚期瘤形成（高度异型增生或结直肠癌），65例进展为任何瘤形成（低度异型增生、高度异型增生或结直肠癌）。单变量分析表明，组织学炎症随时间的变化与进展为晚期肿瘤之间存在显著相关性（风险比（HR）：3.0; IS-均值的95% CI：1.4 - 6.3; IS-分组的HR：3.4; 95% CI：1.1-10.4; IS-最大值的HR：2.2; 95% CI：1.2-4.2）。这种关联在多变量比例风险分析中得以维持。结论：随着时间推移，显微镜下炎症的严重程度是长期UC患者发生晚期结直肠肿瘤的独立风险因素。
Background & Aims: Although inflammation is presumed to contribute to colonic neoplasia in ulcerative colitis (UC), few studies have directly examined this relationship. Our aim was to determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic progression in UC. Methods: A cohort of patients with UC undergoing regular endoscopic surveillance for dysplasia was studied. Degree of inflammation at each biopsy site had been graded as part of routine clinical care using a highly reproducible histologic activity index. Progression to neoplasia was analyzed in proportional hazards models with inflammation summarized in 3 different ways and each included as a time-changing covariate: (1) mean inflammatory score (IS-mean), (2) binary inflammatory score (IS-bin), and (3) maximum inflammatory score (IS-max). Potential confounders were analyzed in univariate testing and, when significant, in a multivariable model. Results: of 418 patients who met inclusion criteria, 15 progressed to advanced neoplasia (high-grade dysplasia or colorectal cancer), and 65 progressed to any neoplasia (low-grade dysplasia, high-grade dysplasia, or colorectal cancer). Univariate analysis demonstrated significant relationships between histologic inflammation over time and progression to advanced neoplasia (hazard ration (HR), 3.0; 95% CI: 1.4 - 6.3 for IS-mean; HR, 3.4; 95% CI: 1.1-10.4 for IS-bin; and HR, 2.2; 95% CI: 1.2-4.2 for IS-max). This association was maintained in multivariable proportional hazards analysis. Conclusions: The severity of microscopic inflammation over time is an independent risk factor for developing advanced colorectal neoplasia among patients with long-standing UC.