Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014.
Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014.
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DOI：
10.1136/bmj.j3951
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发表时间：
2017-09-20
期刊：
影响因子：
--
通讯作者：
Ludvigsson JF
中科院分区：
文献类型：
--
作者：
Olén O;Askling J;Sachs MC;Frumento P;Neovius M;Smedby KE;Ekbom A;Malmborg P;Ludvigsson JF
目的评估儿童期发病的炎症性肠病患者在儿童期和成年期患癌症的风险。 采用多变量考克斯回归估计风险比，设计具有匹配的一般人群参考个体的队列研究。 设置瑞典国家患者登记（住院和非初级门诊护理）1964-2014。 参与者将儿童期发病（<18岁）的炎症性肠病病例（n=9405：溃疡性结肠炎，n=4648;克罗恩病，n=3768;未分类，n=989）与92870例性别、年龄、出生年份和县匹配的一般人群进行比较。 主要结果测量根据瑞典癌症登记的任何癌症和癌症类型。 结果在随访至成年期（随访结束时的中位年龄为27岁），497例（3.3/1000人年）儿童期发病的炎症性肠病患者首次患癌，而一般人群对照组为2256例（1.5/1000人年）（风险比2.2，95%置信区间2.0至2.5）。溃疡性结肠炎中任何癌症的风险比为2.6（2.3至3.0），克罗恩病为1.7（1.5至2.1）。患者在18岁生日前患癌症的风险也增加（2.7，1.6至4.4; 9405例患者中有20例癌症，每1000人年0.6例）。胃肠道癌症的相对风险最高，风险比为18.0（14.4至22.7），对应于炎症性肠病患者中的202例癌症。随着时间的推移，癌症（25岁生日前）的风险增加相似（1964-1989：1.6，1.0至2.4; 1990-2001：2.3，1.5至3.3）; 2002-06：2.9，1.9至4.2; 2007-14：2.2，1.1至4.2）。 结论儿童期发病的炎症性肠病与儿童期和以后生活中任何癌症的风险增加有关，尤其是胃肠道癌症。癌症的高风险并没有随着时间的推移而下降。
Objective To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood. Design Cohort study with matched general population reference individuals using multivariable Cox regression to estimate hazard ratios. Setting Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014. Participants Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn’s disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county. Main outcome measures Any cancer and cancer types according to the Swedish Cancer Register. Results During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn’s disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2). Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time.
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