Inflammation and disease duration have a cumulative effect on the risk of dysplasia and carcinoma in IBD: A case-control observational study based on registry data
Inflammation and disease duration have a cumulative effect on the risk of dysplasia and carcinoma in IBD: A case-control observational study based on registry data
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DOI：
10.1002/ijc.28346
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发表时间：
2014-01-01
影响因子：
6.4
通讯作者：
Farkkila, Martti A.
中科院分区：
文献类型：
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作者：
Nieminen, Urpo;Jussila, Airi;Farkkila, Martti A.
患有长期炎症性肠病（IBD）的患者患结直肠癌（CRC）的风险增加。早期的研究表明，炎症的严重程度是溃疡性结肠炎（UC）中结直肠癌的独立危险因素。我们研究了组织学炎症作为结直肠异常增生或结直肠癌的危险因素的作用，以便更好地针对IBD中的异常增生进行监测。通过结合1996年至2008年的医院患者登记和病理数据库，我们确定了183例伴有不典型增生或结直肠癌的IBD患者。对照组从我们的IBD患者登记处收集。41.4%的非典型增生患者和24.1%的结直肠癌患者存在组织学上的严重炎症，而对照组只有4.3%。与无炎症的患者相比，严重炎症的不良增生或癌患者的优势比（OR）为31.8[95%可信区间（CI）： 15.6-64.9]。在轻度至中度炎症患者中，OR为2.6 （95% CI: 1.6-4.1）。疾病持续时间增加了每年发生异常增生或CRC的风险4.5%。合并原发性硬化性胆管炎（PSC）不会增加风险，而使用硫嘌呤类药物（OR=0.09, 95% CI: 0.02-0.33）和5-氨基水杨酸（OR 0.17, 95% CI: 0.017-1.01）可以预防结直肠癌。综上所述，炎症程度和疾病持续时间累积增加了异常增生和结直肠癌的风险。PSC未被确定为风险因素。我们证明了使用硫嘌呤对结直肠癌有很强的保护作用。这些结果可以更好地用于IBD患者的靶发育不良监测。有什么新鲜事吗?慢性炎症性肠病（IBD）合并溃疡性结肠炎或克罗恩病会增加结直肠癌（CRC）的风险，尽管其原因尚不完全清楚。在这里，对赫尔辛基大学中心医院IBD患者数据的分析表明，与轻度至中度炎症或无炎症的患者相比，严重结肠炎症的患者发生不典型增生或结直肠癌的风险明显更高。随着炎症的程度，IBD的持续时间也会影响风险。另一方面，硫嘌呤和氨基水杨酸的使用与减少发育不良或癌症的风险有关。
Patients with long-standing inflammatory bowel disease (IBD) have an increased risk for colorectal carcinoma (CRC). Earlier studies suggest that the severity of inflammation is an independent risk factor for CRC in ulcerative colitis (UC). We investigated the role of histological inflammation as a risk factor for colorectal dysplasia or CRC to better target dysplasia surveillance in IBD. By combining our hospital patient registry and pathology database between 1996 and 2008, we identified 183 IBD patients with dysplasia or CRC. The control group was collected from our registry of IBD patients. Histological severe inflammation was present in 41.4% of patients with dysplasia and in 24.1% of patients with CRC, but in only 4.3% of controls. Severe inflammation had an odds ratio (OR) of 31.8 [95% confidence interval (CI): 15.6-64.9] for dysplasia or carcinoma compared to patients with no inflammation. Among patients with mild to moderate inflammation, the OR was 2.6 (95% CI: 1.6-4.1). Disease duration increased the annual risk for dysplasia or CRC by 4.5%. Coexisting primary sclerosing cholangitis (PSC) did not elevate the risk, whereas use of thiopurines (OR=0.09, 95% CI: 0.02-0.33) and also 5-aminosalicylic acid (OR 0.17, 95% CI: 0.017-1.01) protected against CRC. As conclusion, degree of inflammation and duration of disease cumulatively increase the risk for dysplasia and CRC. PSC was not identified as a risk factor. We demonstrated that use of thiopurines strongly protects against CRC. These results can be applied to better target dysplasia surveillance in IBD patients.What's new? Chronic inflammatory bowel disease (IBD) with ulcerative colitis or Crohn's disease increases risk of colorectal carcinoma (CRC), though the reasons for this are not fully known. Here, analysis of IBD patient data at Helsinki University Central Hospital suggests that patients with severe colon inflammation are at significantly higher risk for dysplasia or CRC compared with patients with mild to moderate or no inflammation. Along with degree of inflammation, duration of IBD also influenced risk. Use of thiopurines and aminosalicylic acid, on the other hand, was linked to a reduction in risk for dysplasia or carcinoma.