Colorectal cancer in inflammatory bowel disease: What is the real magnitude of the risk?
Colorectal cancer in inflammatory bowel disease: What is the real magnitude of the risk?
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DOI：
10.3748/wjg.v18.i29.3839
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发表时间：
2012-08-07
影响因子：
4.3
通讯作者：
Rutter, Matthew D.
中科院分区：
文献类型：
--
作者：
Dyson, Jessica K.;Rutter, Matthew D.
自1925年以来，炎症性肠病（IBD）和结直肠癌（CRC）之间的关联已被认识到，并且仍然占IBD死亡的10%-45%。IBD相关CRC（IBD-CRC）影响的患者年龄比散发性CRC更小。散发性CRC和IBD-CRC的预后相似，5年生存率约为50%。识别有风险的患者并对这些患者实施适当的监测是管理IBD中CRC风险的核心。与IBD相关的结直肠癌风险增加被认为是由于遗传和获得性因素。炎症和癌症之间的联系是公认的，但IBD-CRC的分子生物学，免疫病理学和遗传学是许多正在进行的研究领域。本文综述了与IBD-结直肠癌相关的文献，重点关注IBD-结直肠癌的发病率，并研究了潜在的危险因素，包括诊断时的年龄、性别、结肠炎的持续时间和程度、炎症的严重程度、散发性结直肠癌的家族史和共存的原发性硬化性胆管炎（PSC）。已确认的IBD-CRC的风险因素是结肠炎的持续时间，严重程度和范围，共存PSC的存在和CRC家族史。目前没有足够的证据支持对较年轻的IBD患者增加监测频率。循证指南建议结肠炎患者在诊断后8至10年进行结肠镜检查，进一步监测的时间间隔由风险因素（疾病程度、CRC家族史、炎后息肉、伴随PSC、结肠发育不良个人史、结肠狭窄）指导。从随机结肠活检转向针对新结肠镜技术（窄带成像、色素内镜、共聚焦显微内镜）确定的异常区域的靶向活检。(c)2012年百世登。All rights reserved.
The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) has been recognised since 1925 and still accounts for 10%45% of deaths in IBD. IBD-associated CRC (IBD-CRC) affects patients at a younger age than sporadic CRC. The prognosis for sporadic CRC and IBD-CRC is similar, with a 5-year survival of approximately 50%. Identifying at risk patients and implementing appropriate surveillance for these patients is central to managing the CRC risk in IBD. The increased risk of colorectal cancer in association with IBD is thought to be due to genetic and acquired factors. The link between inflammation and cancer is well recognised but the molecular biology, immune pathobiology and genetics of IBD-CRC are areas of much ongoing research. This review examines the literature relating to IBD-CRC, focusing on the incidence of IBD-CRC and examining potential risk factors including age at diagnosis, gender, duration and extent of colitis, severity of inflammation, family history of sporadic CRC and co-existent primary sclerosing cholangitis (PSC). Confirmed risk factors for IBD-CRC are duration, severity and extent of colitis, the presence of co-existent PSC and a family history of CRC. There is insufficient evidence currently to support an increased frequency of surveillance for patients diagnosed with IBD at a younger age. Evidence-based guidelines advise surveillance colonoscopy for patients with colitis 8 to 10 years after diagnosis, with the interval for further surveillance guided by risk factors (extent of disease, family history of CRC, post-inflammatory polyps, concomitant PSC, personal history of colonic dysplasia, colonic strictures). There is a move away from using random colonic biopsies towards targeted biopsies aimed at abnormal areas identified by newer colonoscopic techniques (narrow band imaging, chromoendoscopy, confocal microendoscopy). (c) 2012 Baishideng. All rights reserved.