Decreasing Risk of Colorectal Cancer in Patients With Inflammatory Bowel Disease Over 30 Years
Decreasing Risk of Colorectal Cancer in Patients With Inflammatory Bowel Disease Over 30 Years
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DOI：
10.1053/j.gastro.2012.04.016
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发表时间：
2012-08-01
期刊：
影响因子：
29.4
通讯作者：
Frisch, Morten
中科院分区：
文献类型：
--
作者：
Jess, Tine;Simonsen, Jacob;Frisch, Morten
背景与目的：炎症性肠病（IBD）患者患结直肠癌（CRC）的风险可能会随着时间的推移而改变，治疗方案也会发生变化。我们研究了一个全国性队列的47，374名丹麦IBD患者在30年内的CRC风险。方法：我们使用泊松回归推导出的IBD诊断后1年的CRC发病率比值确定相对风险（RR）值，并对年龄、性别和日历时间进行了调整。我们比较了IBD患者与非IBD患者的CRC发病率。研究结果：在1.78亿人-年的随访评估中，268例溃疡性结肠炎（UC）患者和70例克罗恩病（CD）患者发生了CRC。UC患者中CRC的总体风险与一般人群相当（RR，1.07; 95%置信区间[CI]，0.95-1.21）。然而，在儿童或青少年时期诊断为UC的患者、病程较长的患者以及伴有原发性硬化性胆管炎的患者的风险增加。对于UC患者，CRC的总体RR从1979-1988年的1. 34（95% CI，1. 13 - 1. 58）降至1999-2008年的0. 57（95% CI，0. 41 - 0. 80）。在CD患者中，CRC的总体RR为0.85（95% CI，0.67-1.07），未随时间变化。结论：UC或CD的诊断似乎不再增加患者CRC的风险，尽管UC患者亚组的风险仍然增加。从1979年到2008年，CRC的风险降低可能是由于IBD患者治疗方法的改进。
BACKGROUND & AIMS: The risk for colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) could have changed over time, with changes in treatment options. We studied CRC risk in a nationwide cohort of 47,374 Danish patients with IBD over a 30-year period. METHODS: We determined relative risk (RR) values using Poisson regression-derived incidence rate ratios of CRC from 1 year after IBD diagnosis, adjusted for age, sex, and calendar time. We compared incidence of CRC among patients with IBD vs individuals without IBD. RESULTS: During 178 million person-years of follow-up evaluation, 268 patients with ulcerative colitis (UC) and 70 patients with Crohn's disease (CD) developed CRC. The overall risk of CRC among patients with UC was comparable with that of the general population (RR, 1.07; 95% confidence interval [CI], 0.95-1.21). However, patients diagnosed with UC in childhood or as adolescents, those with long duration of disease, and those with concomitant primary sclerosing cholangitis were at increased risk. For patients with UC, the overall RR for CRC decreased from 1.34 (95% CI, 1.13-1.58) in 1979-1988 to 0.57 (95% CI, 0.41-0.80) in 1999-2008. Among patients with CD, the overall RR for CRC was 0.85 (95% CI, 0.67-1.07), which did not change over time. CONCLUSIONS: A diagnosis of UC or CD no longer seems to increase patients' risk of CRC, although subgroups of patients with UC remain at increased risk. The decreasing risk for CRC from 1979 to 2008 might result from improved therapies for patients with IBD.