High frequency of early colorectal cancer in inflammatory bowel disease
High frequency of early colorectal cancer in inflammatory bowel disease
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DOI：
10.1136/gut.2007.143453
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发表时间：
2008-09-01
期刊：
影响因子：
24.5
通讯作者：
Samsom, M.
中科院分区：
文献类型：
--
作者：
Lutgens, M. W. M. D.;Vleggaar, F. P.;Samsom, M.
背景和目标：为了发现癌前异型增生或无症状的癌症，患有炎症性肠病的患者通常根据美国或英国的指南进行结肠镜监测。建议在广泛性结肠炎8-10年后或左侧疾病15-20年后开始监测。然而，这些出发点并没有坚实的科学证据为基础。我们的目的是评估炎症性肠病（IBD）和结直肠癌（CRC）发病之间的时间间隔，并随后评估在建议开始监测之前有多少患者发展为癌症。方法：查阅全国自动病理学数据库（PALGA）以识别IBD患者。1990年1月至2006年6月期间，荷兰7所大学医学中心的相关结直肠癌。从患者病历中回顾性收集数据。疾病发作和癌症诊断之间的时间间隔计算months.Results：149例患者被确定为IBD和CRC的确诊（溃疡性结肠炎n = 89/克罗恩病n = 59/不确定性结肠炎n = 1）。以诊断日期为切入点，22%的患者在8年或15年的监测起点之前发生癌症，如果在诊断广泛或左侧疾病后10年或20年开始监测，则分别为28%。使用发病的症状来计算的时间间隔，17-22%的患者将目前与癌症前的监测startingpoints.Conclusions：这些结果表明，结直肠癌的诊断是延迟或错过了相当数量的患者（17-28%）时，严格按照正式的指导方针进行监测。
Background and aim: To detect precancerous dysplasia or asymptomatic cancer, patients suffering from inflammatory bowel disease often undergo colonoscopic surveillance based on American or British guidelines. It is recommended that surveillance is initiated after 8-10 years of extensive colitis, or after 15-20 years for left-sided disease. These starting points, however, are not based on solid scientific evidence. Our aim was to assess the time interval between onset of inflammatory bowel disease (IBD) and colorectal carcinoma (CRC), and subsequently evaluate how many patients developed cancer before their surveillance was recommended to commence.Methods: A nationwide automated pathology database (PALGA) was consulted to identify patients with IBD-associated colorectal carcinoma in seven university medical centres in The Netherlands between January 1990 and June 2006. Data were collected retrospectively from patient charts. Time intervals between onset of disease and cancer diagnosis were calculated in months.Results: 149 patients were identified with confirmed diagnoses of IBD and CRC (ulcerative colitis n = 89/Crohn's disease n = 59/indeterminate colitis n = 1). Taking date of diagnosis as the entry point, 22% of patients developed cancer before the 8 or 15 year starting points of surveillance, and 28% if surveillance was commenced 10 or 20 years after diagnosis for extensive or left-sided disease, respectively. Using onset of symptoms to calculate the time interval, 17-22% of patients would present with cancer prior to the surveillance starting points.Conclusions: These results show that the diagnosis of colorectal cancer is delayed or missed in a substantial number of patients (17-28%) when conducting surveillance strictly according to formal guidelines.