潰瘍性結腸炎患者得結直腸癌的風險較高
作者：
小柯機器人發布時間：2020/1/13 14:39:51
潰瘍性結腸炎中結直腸癌的患病率—基於斯堪地那維亞人群的隊列研究，這一成果由瑞典卡羅萊納研究所Ola Olén小組取得。2020年1月11日，《柳葉刀》發表了這項成果。
潰瘍性結腸炎（UC）是結直腸癌（CRC）的危險因素。然而，現有的治療和檢測模式較為落後，大多數研究在未考慮監測和癌前偏倚的情況下，就對CRC的風險進行了評估，例如通過腫瘤分期來評估CRC的發病率，或根據CRC分期來分段校正死亡率。
為了比較UC患者中CRC患病率和死亡率的總體風險和國別風險，1969年1月1日至2017年12月31日，研究組對來自丹麥和瑞典的96447名UC患者進行了一項基於人群的隊列研究，並與一般資料匹配的949207名普通人群進行對照比較。
在隨訪期間，研究組發現UC隊列中共發生1336例CRC，發病率為1.29/1000人年，對照隊列中有9544例，發病率為0.82/1000人年。UC隊列中有639例患者死於CRC，死亡率為0.55/1000人年，對照隊列中有4451例，死亡率為0.38/1000人年。UC隊列中CRC晚期的分布比低於對照隊列，但考慮到腫瘤分期，UC隊列中CRC患者的CRC死亡風險顯著增加。在過去5年（2013-2017，僅在瑞典進行）的隨訪中，UC患者發生CRC的風險比為1.38，CRC死亡的風險比為1.25。
研究結果表明，與沒有UC的患者相比，UC患者患CRC的風險更高，但較少被確診為晚期CRC，因CRC而死亡的風險也很高，儘管隨著時間推移，這些過度風險已大大降低。
附：英文原文
Title: Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study
Author: Ola Olén, Rune Erichsen, Michael C Sachs, Lars Pedersen, Jonas Halfvarson, Johan Askling, Anders Ekbom, Henrik Toft Srensen, Jonas F Ludvigsson
Issue&Volume: 2020/01/11
Abstract:
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<0·0001) than in matched reference individuals, but taking tumour stage into account, patients with UC and CRC remained at increased risk of CRC death (HR 1·54, 95% CI 1·33–1·78). The excess risks declined over calendar periods: during the last 5 years of follow-up (2013–17, Sweden only), the HR for incident CRC in people with UC was 1·38 (95% CI 1·20–1·60, or one additional case per 1058 patients with UC per 5 years) and the HR for death from CRC was 1·25 (95% CI 1·03–1·51, or one additional case per 3041 patients with UC per 5 years).
Interpretation
Compared with those without UC, individuals with UC are at increased risk of developing CRC, are diagnosed with less advanced CRC, and are at increased risk of dying from CRC, although these excess risks have declined substantially over time. There still seems to be room for improvement in international surveillance guidelines.
DOI: 10.1016/S0140-6736(19)32545-0
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32545-0/fulltext