Predictive and protective factors associated with colorectal cancer in ulcerative colitis: A case-control study
Predictive and protective factors associated with colorectal cancer in ulcerative colitis: A case-control study
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DOI：
10.1053/j.gastro.2006.03.028
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发表时间：
2006-06-01
期刊：
影响因子：
29.4
通讯作者：
Sandborn, William J.
中科院分区：
文献类型：
--
作者：
Velayos, Fernando S.;Lofrus, Edward V., Jr.;Sandborn, William J.
背景和目的：与慢性溃疡性结肠炎中结直肠癌相关的预测和保护因素尚未得到很好的描述。监测结肠镜检查和 5-氨基水杨酸治疗可能会降低癌症风险，但存在争议，因为这些变量尚未在同一研究中进行评估。炎症后假息肉的存在和其他抗炎药物的使用可能是影响风险的重要变量，但数据很少。方法：在 188 名溃疡性结肠炎相关癌症患者和匹配对照患者中登记与结直肠癌相关的变量。根据结肠炎诊断时的年龄和结肠炎持续时间进行调整的条件逻辑回归确定了一组与结直肠癌独立相关的最终变量。结果：在最终的多变量模型中，与结直肠癌相关的最重要因素是假息肉病史（OR，2.5；95% CI：14-4.6）、1 或 2 次结肠镜监测（OR，0.4；95% CI：0.2-0.7）、吸烟（OR，0.5；95% CI：0.2-0.9）和皮质类固醇的使用（OR，0.4；95% CI：0.2-0.8）、阿司匹林（OR，0.3；95% CI：0.1-0.8）、非甾体抗炎药（OR，0.1；95% CI：0.03-0.5）和 5-氨基水杨酸药物（OR，0.4；95% CI：0.2-0.9），尽管后者在 5 年后没有统计学意义。原发性硬化性胆管炎和免疫抑制剂的使用没有统计学意义。结论：这些结果表明，在与慢性溃疡性结肠炎的程度和持续时间相匹配的人群中，监测结肠镜检查和使用抗炎药物可能会降低结直肠癌的风险。炎症后假息肉病史似乎是癌症的预测因素。
Background & Aims: Predictive and protective factors associated with colorectal cancer in chronic ulcerative colitis are not well described. Surveillance colonoscopy and 5-aminosalicylic acid therapy may mitigate cancer risk, but there is debate because these variables have not been evaluated in the same study. The presence of postinflammatory pseudopolyps and use of other anti-inflammatory medications may be important variables that influence risk, but data are sparse. Methods: Variables associated with colorectal cancer were registered in 188 patients with ulcerative colitis-related cancer and matched controls. Conditional logistic regression, adjusted for age at colitis diagnosis and colitis duration, identified a final set of variables independently associated with colorectal cancer. Results: In the final multiple variable model, the most important factors associated with colorectal cancer were a history of pseudopolyps (OR, 2.5; 95% CI: 14-4.6), 1 or 2 surveillance colonoscopies (OR, 0.4; 95% CI: 0.2-0.7), smoking (OR, 0.5; 95% CI: 0.2-0.9) and use of corticosteroids (OR, 0.4; 95% CI: 0.2-0.8), aspirin (OR, 0.3; 95% CI: 0.1-0.8), nonsteroidal anti-inflammatory drugs (OR, 0.1; 95% CI: 0.03-0.5), and 5-aminosalicylic acid agents (OR, 0.4; 95% CI: 0.2-0.9), although the latter was not statistically significant after 5 years. Primary sclerosing cholangitis and immunosuppressive use were not statistically significant. Conclusions: These results suggest that, in a population matched for extent and duration of chronic ulcerative colitis, surveillance colonoscopy and use of anti-inflammatory medications may reduce the risk of colorectal cancer. A history of postinflammatory pseudopolyps appears to be a predictive factor for cancer.