Duration of Inflammatory Bowel Disease Is Associated With Increased Risk of Cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis and IBD.
Duration of Inflammatory Bowel Disease Is Associated With Increased Risk of Cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis and IBD.
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DOI：
10.1038/ajg.2016.55
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发表时间：
2016-05
影响因子：
9.8
通讯作者：
Lazaridis, Konstantinos N.
中科院分区：
文献类型：
--
作者：
Gulamhusein, Aliya F.;Eaton, John E.;Tabibian, James H.;Atkinson, Elizabeth J.;Juran, Brian D.;Lazaridis, Konstantinos N.
原发性硬化性胆管炎（PSC）通常与炎症性肠病（IBD）并存，并可并发胆管癌（CCA），这是一种致命的恶性肿瘤，其可靠的预测因子仍未知。我们的目的是描述结肠切除术和IBD持续时间对PSC-IBD患者CCA风险的影响。对2005年1月至2013年5月期间在罗切斯特的马约诊所就诊的PSC-IBD患者进行了回顾性审查。主要结果是发展CCA的时间，我们的目标是确定结肠切除术和未切除结肠的患者之间的风险是否不同。采用单变量和多变量考克斯比例风险模型评估风险因素，其中结肠切除术、IBD病程和晚期肝病的发展作为时间依赖性协变量。共有399例PSC-IBD患者纳入研究，其中137例接受结肠切除术，123例发生CCA。单因素考克斯比例风险模型表明，结肠切除术（风险比（HR）1.53，95%置信区间（CI）1.05-2.22，P =0.02）和IBD持续时间（HR 1.37，95%CI 1.15-1.63，P <0.01）与CCA、结肠肿瘤的风险增加相关（HR 1.52，95% CI 0.97-2.37，P =0.06）和结肠肿瘤切除术（HR 1.62，95% CI 1.01-2.61，P =0.05）接近显著性。在有结肠切除术史的患者中，与医学难治性疾病相比，结肠肿瘤作为手术指征与CCA风险特别增加相关（HR 2.91，95% CI 1.24-6.84，P =0.01）。多因素分析显示IBD病程与CCA显著相关（HR 1.33，95% CI 1.11-1.60，P <0.01）。IBD持续时间对CCA风险的影响在结肠切除术后没有改变（P =0.69）。IBD持续时间延长与PSC IBD患者CCA风险增加相关，结肠切除术本身并不能改变这种风险。这些发现确定了一个亚组的患者谁是这种致命的并发症的高风险，需要密切监测。
Primary sclerosing cholangitis (PSC) often coexists with inflammatory bowel disease (IBD) and can be complicated by cholangiocarcinoma (CCA), a lethal malignancy for which reliable predictors remain unknown. We aimed to characterize the influence of colectomy and IBD duration on risk of CCA in patients with PSC-IBD. A retrospective review of patients with PSC-IBD seen at the Mayo Clinic, Rochester, between January 2005 and May 2013 was performed. The primary outcome was time to development of CCA and our goal was to determine whether the risk differed between patients with and without colectomy. Risk factors were assessed using univariable and multivariable Cox proportional hazard models where colectomy, IBD disease duration, and development of advanced liver disease were treated as time-dependent covariates. A total of 399 patients with PSC-IBD were included in the study, of whom 137 had a colectomy and 123 patients developed CCA. Age-adjusted univariate Cox proportional hazard models demonstrated that colectomy (hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.05–2.22, P =0.02) and duration of IBD (HR 1.37, 95% CI 1.15–1.63, P <0.01) were associated with an increased risk of CCA, and colonic neoplasia (HR 1.52, 95% CI 0.97–2.37, P =0.06) and colectomy for colonic neoplasia (HR 1.62, 95% CI 1.01–2.61, P =0.05) approached significance. Among patients with a history of colectomy, colonic neoplasia as the indication for surgery was associated with a particularly increased risk of CCA (HR 2.91, 95% CI 1.24–6.84, P =0.01) compared with medically refractory disease. On multivariate analysis, duration of IBD remained significantly associated with CCA (HR 1.33, 95% CI 1.11–1.60, P <0.01). The influence of IBD duration on CCA risk was not modified after colectomy (P =0.69). Prolonged duration of IBD is associated with an increased risk of CCA in patients with PSC-IBD, and colectomy itself does not modify this risk. These findings identify a subset of patients who are at high risk of this lethal complication and in need of close surveillance.
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影响因子：
1.9
作者：
Boberg, KM;Bergquist, A;Schrumpf, E
通讯作者：
Schrumpf, E
影响因子：
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作者：
Boonstra, Kirsten;van Erpecum, Karel J.;Ponsioen, Cyriel Y.
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Ponsioen, Cyriel Y.
影响因子：
1.9
作者：
HYLANDER, E;LADEFOGED, K;JARNUM, S
通讯作者：
JARNUM, S