Relationship between clinical parameters and the colitis-colorectal cancer interval in a cohort of patients with colorectal cancer in inflammatory bowel disease
Relationship between clinical parameters and the colitis-colorectal cancer interval in a cohort of patients with colorectal cancer in inflammatory bowel disease
复制标题
DOI：
10.1080/00365520801977568
复制
发表时间：
2009-01-01
影响因子：
1.9
通讯作者：
Vatn, Morten H.
中科院分区：
文献类型：
--
作者：
Brackmann, Stephan;Andersen, Solveig N.;Vatn, Morten H.
Objective.炎症性肠病（IBD）与结直肠癌（CRC）风险增加有关，但需要更多关于IBD临床参数与癌症发展时间之间可能关系的知识。该研究的目的是确定结肠炎-结直肠癌间隔的变异性，并分析其与临床变量的相关性，以获得相对较大的结直肠癌患者队列中癌症发生时间的预测因素的信息。材料和方法。将2005年5月1日之前在奥斯陆的三所大学医院诊断为IBD的患者与挪威癌症登记处的CRC文件进行匹配。仅纳入组织学再次确认的IBD和结直肠腺癌。结果确定了61例溃疡性结肠炎CRC患者和6例克罗恩病CRC患者，包括13例原发性硬化性胆管炎（PSC）CRC患者，随访时间为1625患者年。从IBD诊断到CRC的中位时间为17年。58例患者中有7例（12%）在IBD症状发作后10年内发生CRC，14/67例（21%）在IBD诊断后10年内发生CRC。当IBD发病时的年龄增加一岁时，结肠炎-结直肠癌间隔减少了0.154倍（p = 0.018）。Dukes分期C或D患者IBD发作时的平均年龄为30岁，而Dukes分期A或B患者为20岁（p = 0.017）。当结肠炎-CRC间隔的百分比增加1%时，结肠炎-CRC间隔减少0.138倍（p = 0.003）。患有PSC的患者在出现IBD症状时明显年轻（+ PSC：19岁与无PSC：29岁，p = 0.04），但结肠炎-CRC间隔与无PSC的IBD相似（17岁与20岁，p = 0.236）。结肠炎-结直肠癌间隔的平均持续时间与家族史或结直肠癌前的药物消耗无关。结论.在本队列中，从IBD诊断到CRC的中位时间为17年，21%的癌症在疾病发生10年之前发展，这通常是在结肠镜筛查之前推荐的。IBD发病时的高年龄可能与IBD中CRC的更具侵袭性的发展有关，并且可能考虑对该组患者进行早期筛查。症状活动而不是PSC的诊断，CRC或IBD的家族史或药物治疗似乎对结肠炎-CRC间隔有影响。
Objective. Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC), but more knowledge is needed about the possible relationship between clinical parameters and the time to development of cancer in IBD. The aim of the study was to determine the variability of the colitis-CRC interval and to analyze the association with clinical variables in an attempt to gain information on predictive factors of time to cancer within a relatively large cohort of CRC patients. Material and methods. Patients diagnosed with IBD prior to 1 May 2005 at three university hospitals in Oslo were matched against the CRC files at the Cancer Registry of Norway. Only histological re-confirmed IBD and adenocarcinoma of the colorectum were included. Results. Sixty-one patients with CRC in ulcerative colitis and 6 in Crohn's disease, including 13 CRC in primary sclerosing cholangitis (PSC), covering a follow-up of 1625 patient years, were identified. The median time from diagnosis of IBD to CRC was 17 years. Seven of 58 patients (12%) developed CRC within 10 years from onset of IBD symptoms and 14/67 (21%) within 10 years after the diagnosis of IBD. The colitis-CRC interval decreased by a factor of 0.154 (p = 0.018) when age at onset of IBD increased by one year. Mean age at onset of IBD was 30 years in patients with Dukes' stage C or D compared with 20 years in Dukes' stage A or B patients (p = 0.017). The colitis-CRC interval decreased by a factor of 0.138 (p = 0.003) when the percentage of the colitis-CRC interval with active symptoms increased by 1%. Patients with PSC were significantly younger at onset of IBD symptoms (+ PSC: 19 years versus no PSC: 29 years, p = 0.04), but the colitis-CRC interval was similar to IBD without PSC (17 years versus 20 years, p = 0.236). Mean duration of the colitis-CRC interval was not related to family history or drug consumption prior to CRC. Conclusions. In the present cohort, for whom the median time from diagnosis of IBD to CRC was 17 years, 21% of the cancers developed before 10 years of disease, which is before colonoscopic screening is usually recommended. High age at onset of IBD may be related to a more aggressive development of CRC in IBD and early inclusion in screening programs might be considered for this group of patients. Symptom activity but not the diagnosis of PSC, family history of CRC or IBD or drug treatment seems to have an effect on the colitis-CRC interval.