Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study
Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study
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DOI：
10.1016/s0140-6736(19)32545-0
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发表时间：
2020-01-11
期刊：
影响因子：
168.9
通讯作者：
Ludvigsson, Jonas F.
中科院分区：
文献类型：
--
作者：
Olen, Ola;Erichsen, Rune;Ludvigsson, Jonas F.
背景溃疡性结肠炎(UC)是结直肠癌(CRC)的危险因素。然而，现有的研究反映了较老的治疗和监测范例，大多数都评估了偶发结直肠癌的风险，而没有考虑监测和提前时间偏差，例如通过评估肿瘤分期的结直肠癌发病率，或结直肠癌分期调整后的死亡率。方法在丹麦(n=32 919)和瑞典(n=63 528)96 447例UC患者中进行了基于人群的队列研究，对1969年1月1日至2017年12月31日期间的患者进行了CRC发病率和CRC死亡率的随访，并与普通人群中匹配的参考者(n=949 207)进行了比较。UC患者是从国家登记中挑选出来的，如果他们在患者登记中(在相关国家)有两个或更多相关国际疾病分类的记录，或者有一个这样的记录加上具有提示炎症性肠道疾病的形态代码的结直肠活检报告，则将其纳入分析。对于每个UC患者，我们从丹麦和瑞典的总人口登记中选择匹配的参考个体，他们在性别、年龄、出生年份和居住地方面匹配。我们使用COX回归来计算包括肿瘤分期在内的偶发性结直肠癌和结直肠癌死亡率的风险比(HR)。在随访期间，我们在UC队列中观察到1336例发生CRC(每1000人年1.29例)和9544例参考个体(每1000人年0.82例；HR 1.66，95%可信区间1.57-1.76)。在UC队列中，639名患者死于结直肠癌(每1000人年0.55人)，而同期参照者为4451人(每1000人年0.38人；HR 1.59，95%CI 1.46-1.72)。UC患者的结直肠癌分期分布较慢(p
Background Ulcerative colitis (UC) is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance paradigms, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account, such as by assessing CRC incidence by tumour stage, or stage-adjusted mortality from CRC. We aimed to compare both overall and country-specific risks of CRC mortality and incident CRC among patients with UC.Methods In this population-based cohort study of 96 447 patients with UC in Denmark (n=32 919) and Sweden (n=63 528), patients were followed up for CRC incidence and CRC mortality between Jan 1, 1969, and Dec 31, 2017, and compared with matched reference individuals from the general population (n=949 207). Patients with UC were selected from national registers and included in the analysis if they had two or more records with a relevant International Classification of Disease in the patient register (in the country in question) or one such record plus a colorectal biopsy report with a morphology code suggestive of inflammatory bowel disease. For every patient with UC, we selected matched reference individuals from the total population registers of Denmark and Sweden, who were matched for sex, age, birth year, and place of residence. We used Cox regression to compute hazard ratios (HRs) for incident CRC, and for CRC mortality, taking tumour stage into account.Findings During follow-up, we observed 1336 incident CRCs in the UC cohort (1.29 per 1000 person-years) and 9544 incident CRCs in reference individuals (0.82 per 1000 person-years; HR 1.66, 95% CI 1.57-1.76). In the UC cohort, 639 patients died from CRC (0.55 per 1000 person-years), compared with 4451 reference individuals (0.38 per 1000 person-years; HR 1.59, 95% CI 1.46-1.72) during the same time period. The CRC stage distribution in people with UC was less advanced (p