溃疡性结肠炎中结直肠癌的患病率—基于斯堪的纳维亚人群的队列研究，这一成果由瑞典卡罗莱纳研究所Ola Olén小组取得。2020年1月11日，《柳叶刀》发表了这项成果。
溃疡性结肠炎（UC）是结直肠癌（CRC）的危险因素。然而，现有的治疗和检测模式较为落后，大多数研究在未考虑监测和癌前偏倚的情况下，就对CRC的风险进行了评估，例如通过肿瘤分期来评估CRC的发病率，或根据CRC分期来分段校正死亡率。
为了比较UC患者中CRC患病率和死亡率的总体风险和国别风险，1969年1月1日至2017年12月31日，研究组对来自丹麦和瑞典的96447名UC患者进行了一项基于人群的队列研究，并与一般资料匹配的949207名普通人群进行对照比较。
在随访期间，研究组发现UC队列中共发生1336例CRC，发病率为1.29/1000人年，对照队列中有9544例，发病率为0.82/1000人年。UC队列中有639例患者死于CRC，死亡率为0.55/1000人年，对照队列中有4451例，死亡率为0.38/1000人年。UC队列中CRC晚期的分布比低于对照队列，但考虑到肿瘤分期，UC队列中CRC患者的CRC死亡风险显著增加。在过去5年（2013-2017，仅在瑞典进行）的随访中，UC患者发生CRC的风险比为1.38，CRC死亡的风险比为1.25。
研究结果表明，与没有UC的患者相比，UC患者患CRC的风险更高，但较少被确诊为晚期CRC，因CRC而死亡的风险也很高，尽管随着时间推移，这些过度风险已大大降低。
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
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