Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis.
Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis.
复制标题
原发性硬化性胆管炎和溃疡性结肠炎患者结肠肿瘤的风险和自然史。
作者：
T. Brentnall;R. Haggitt;P. S. Rabinovitch;M. Kimmey;M. Bronner;Douglas S. Levine;Kris V. Kowdley;A. Stevens;David A. Crispin;M. Emond;Cyrus E. Rubin
背景与目标
原发性硬化性胆管炎（PSC）已被认为是溃疡性结肠炎（UC）发生结直肠癌的危险因素;然而，以前对这种相关性的研究受到PSC患者数量较少或回顾性研究的限制。本研究前瞻性评估了PSC和UC患者结肠肿瘤发生的风险和自然史，并将其与无PSC的UC患者进行比较。
方法
对20例PSC和UC患者以及25例UC对照患者进行前瞻性随访，采用广泛的粘膜活检取样进行结肠镜监测。所有对照组UC患者的病程超过乙状结肠>或= 8年; PSC和UC患者的研究与病程无关。
结果
45%（9/20）的PSC和UC患者患有异型增生，而对照UC患者的异型增生率为16%（4/25）（P < or = 0.002）。先前的肝移植并不影响结肠发育不良的风险。PSC和UC患者与UC患者之间进展为异型增生的时间进程相似;然而，PSC和UC患者发生异型增生的可能性高5倍。
结论
PSC和UC患者代表结肠肿瘤风险显著增加且需要通过广泛活检采样进行密切结肠镜监测的UC患者亚组。
BACKGROUND & AIMS
Primary sclerosing cholangitis (PSC) has been suggested as a risk factor for the development of colorectal cancer in ulcerative colitis (UC); however, previous studies of this association have been limited by small numbers of patients with PSC or have been performed retrospectively. This study prospectively evaluates the risk and natural history of colonic tumorigenesis in patients with PSC and UC and compares it with patients with UC without PSC.
METHODS
Twenty patients with PSC and UC and 25 control patients with UC were followed prospectively by colonoscopic surveillance using extensive mucosal biopsy sampling. All control patients with UC had disease extending beyond the sigmoid colon of > or = 8 years' duration; patients with PSC and UC were studied regardless of disease duration.
RESULTS
Forty-five percent (9 of 20) of the patients with PSC and UC had dysplasia compared with 16% (4 of 25) of the control patients with UC (P < or = 0.002). Prior liver transplantation did not affect the risk of colonic dysplasia. The time course for progression to dysplasia was similar between the patients with PSC and UC and the patients with UC; however, the patients with PSC and UC were five times more likely to develop dysplasia.
CONCLUSIONS
Patients with PSC and UC represent a subset of patients with UC who are at markedly increased risk for colonic neoplasia and who need close colonoscopic surveillance with extensive biopsy sampling.