PRIMARY SCLEROSING CHOLANGITIS AND ULCERATIVE-COLITIS - EVIDENCE FOR INCREASED NEOPLASTIC POTENTIAL

PRIMARY SCLEROSING CHOLANGITIS AND ULCERATIVE-COLITIS - EVIDENCE FOR INCREASED NEOPLASTIC POTENTIAL
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DOI：
10.1016/0270-9139(95)90144-2
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发表时间：
1995-11-01
期刊：
HEPATOLOGY
影响因子：
13.5
通讯作者：
ERIKSSON, LS
ERIKSSON, LS
中科院分区：
医学1区
文献类型：
--
作者：
BROOME, U;LOFBERG, R;ERIKSSON, LS

文献摘要

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原发性硬化性胆管炎是一种胆道破坏性疾病，主要影响溃疡性结肠炎(UC)患者。PSC已被认为是UC发生结直肠癌的独立危险因素。患有PSC的患者患胆管癌的风险也增加。本研究旨在评估PSC和UC中结直肠肿瘤的累积风险，并确定发生胆管癌的危险因素。纳入58例PSC患者。40例广泛性结肠炎的PSC患者与两名相同年龄、广泛性结肠炎和类似持续时间的对照组患者配对，但没有PSC。所有UC患者均接受了结肠镜检查和多次活检。在40例PSC合并UC的患者中，16例发展为结肠不典型增生或癌，而对照组为10例(P&lt；.001)。经过10年、20年和25年的病程，PSC/UC组发生结直肠异型增生/癌的绝对累积风险分别为9%、31%和50%。在仅有UC的组中，相应的风险分别为2%、5%和10%(P&lt；.001)。10例PSC患者发展为胆管癌，除1例外，其余均为UC。对照组无一例发生胆管细胞癌。PSC和UC伴结直肠肿瘤的患者发生胆管癌的几率显著高于UC和PSC不伴结肠异型增生/癌的患者(P&lt；0.02)。本研究不仅表明PSC和UC患者发生结直肠癌的风险显著高于单纯UC患者，而且PSC和UC患者发生结直肠癌的风险也更高。
Primary sclerosing cholangitis BSC) is a biliary destructive disease mostly affecting patients with ulcerative colitis (UC). PSC has been suggested to be an independent risk factor for the development of colorectal malignancy in UC. Patients with PSC also have an increased risk of developing cholangiocarcinoma. This study aimed at assessing the cumulative risk of colorectal neoplasia in PSC and UC, and also to determine risk factors for the development of cholangiocarcinoma. Fifty-eight PSC patients were included. Forty PSC patients having extensive UC were each matched to two control patients of the same age, with extensive colitis and a comparable duration of the colitis, but without PSC. All UC patients had been under colonoscopic surveillance with multiple biopsies. Among the 40 PSC patients with UC, 16 developed colonic dysplasia or carcinoma, versus 10 in the control group (P < .001). The absolute cumulative risk of developing colorectal dysplasia/carcinoma in the PSC/UC groups was 9%, 31%, and 50% after 10 20, and 25 years of disease duration. In the group with UC only,the corresponding risk was 2%, 5%, and 10%, respectively (P < .001). Ten patients with PSC developed cholangiocarcinoma, all but one having UC. In the control group, no cholangiocarcinoma occurred. Patients with PSC and UC with colorectal neoplasia developed cholangiocarcinoma significantly more often compared with patients with UC and PSC without colonic dysplasia/carcinoma (P < .02). This study demonstrates not only that patients with PSC and UC have a significantly higher risk of developing colorectal neoplasia compared with patients having UC only, but also that patients with PSC and UC having colorectal neoplasia are more prone to develop cholangiocarcinoma.