Freeman Hugh J
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia.
Can J Gastroenterol. 2002 Nov;16(11):779-84. doi: 10.1155/2002/193285.
A variety of malignant complications occur in Crohn's disease, and previous studies have recorded an increased intestinal cancer risk. The present investigation tabulated myeloid and lymphoid malignancies compared with intestinal cancers in 1000 consecutively evaluated patients with Crohn's disease who were followed over an extended period by a single clinician. Myeloid and lymphoid neoplasms were present in 0.5% of patients, while cancer in the intestinal tract was detected in 1%. Most of these patients with a malignancy had Crohn's disease for a prolonged period of more than 20 years and had negative outcomes, including death or presentations with advanced disease. In this cohort, lymphoma was not detected in a single patient after definition of Crohn's disease, possibly reflecting the limited use of immunosuppressives or infused biological agents in this clinical practice. Bypassed rectal 'stumps' were associated with subsequent colorectal cancer in half of all males with colon cancer in this series, suggesting an important risk factor following colectomy in Crohn's disease. Epithelial dysplasia was detected in only a single male patient before colorectal cancer, implying that this histopathological marker may be a poor predictor of subsequent colon cancer development in Crohn's disease, an inflammatory bowel disease process that is typically patchy or focal in distribution in the intestinal tract.
克罗恩病会出现多种恶性并发症，既往研究已记录其患肠癌风险增加。本研究将1000例连续接受评估的克罗恩病患者的髓系和淋巴系恶性肿瘤与肠道癌进行了列表分析，这些患者由一名临床医生进行了长期随访。髓系和淋巴系肿瘤在0.5%的患者中出现，而肠道癌在1%的患者中被检测到。这些患有恶性肿瘤的患者大多患有克罗恩病超过20年，且预后不良，包括死亡或出现晚期疾病。在这个队列中，在明确克罗恩病诊断后，没有一名患者被检测出患有淋巴瘤，这可能反映了该临床实践中免疫抑制剂或注射用生物制剂的使用有限。在本系列中，所有结肠癌男性患者中有一半的绕过直肠“残端”与随后的结直肠癌相关，这表明在克罗恩病患者行结肠切除术后这是一个重要的危险因素。在结直肠癌发生前，仅在一名男性患者中检测到上皮发育异常，这意味着这种组织病理学标志物可能不是克罗恩病患者随后结肠癌发生的良好预测指标，克罗恩病是一种炎症性肠病，其在肠道中的分布通常是散在的或局灶性的。
