Rutter Matthew D, Saunders Brian P, Wilkinson Kay H, Rumbles Steve, Schofield Gillian, Kamm Michael A, Williams Christopher B, Price Ashley B, Talbot Ian C, Forbes Alastair
Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Teesside, England.
Gastroenterology. 2006 Apr;130(4):1030-8. doi: 10.1053/j.gastro.2005.12.035.
BACKGROUND & AIMS: The value of colonoscopic surveillance for neoplasia in long-standing extensive ulcerative colitis remains controversial. This study reports on prospectively collected data from a surveillance program over a 30-year period.
Data were obtained from the prospective surveillance database, medical records, colonoscopy, and histology reports. The primary end point was defined as death, colectomy, withdrawal from surveillance, or census date (January 1, 2001). Follow-up information was obtained for patients who left the program.
Six hundred patients underwent 2627 colonoscopies during 5932 patient-years of follow-up. The cecal intubation rate was 98.7%, with no significant complications. Seventy-four patients (12.3%) developed neoplasia, including 30 colorectal cancers (CRCs). There was no difference in median age at onset of colitis for those with or without CRC (P = .8, Mann-Whitney). The cumulative incidence of CRC by colitis duration was 2.5% at 20 years, 7.6% at 30 years, and 10.8% at 40 years. The 5-year survival rate was 73.3%. Sixteen of 30 cancers were interval cancers. CRC incidence decreased over time (r = -.40, P = .04; linear regression).
Colonoscopic surveillance is safe and allows the vast majority of patients to retain their colon. Although two thirds of patients with potentially life-threatening neoplasia benefited from surveillance, the program was not wholly effective in cancer prevention. The cancer incidence, however, was considerably lower than in the majority of other studies, and was constant for up to 40 years of colitis duration, suggesting there is no need to intensify surveillance over time.
长期广泛溃疡性结肠炎患者进行结肠镜检查监测肿瘤的价值仍存在争议。本研究报告了一项为期30年的监测项目前瞻性收集的数据。
数据来自前瞻性监测数据库、病历、结肠镜检查及组织学报告。主要终点定义为死亡、结肠切除术、退出监测或普查日期（2001年1月1日）。对退出该项目的患者获取随访信息。
600例患者在5932患者年的随访期间接受了2627次结肠镜检查。盲肠插管率为98.7%，无显著并发症。74例患者（12.3%）发生肿瘤，包括30例结直肠癌（CRC）。患CRC和未患CRC患者的结肠炎发病年龄中位数无差异（P = 0.8，Mann-Whitney检验）。根据结肠炎病程，CRC的累积发病率在20年时为2.5%，30年时为7.6%，40年时为10.8%。5年生存率为73.3%。30例癌症中有16例为间期癌。CRC发病率随时间下降（r = -0.40，P = 0.04；线性回归）。
结肠镜检查监测是安全的，并且能使绝大多数患者保留结肠。虽然三分之二患有潜在危及生命肿瘤的患者从监测中获益，但该项目在癌症预防方面并非完全有效。然而，癌症发病率明显低于大多数其他研究，并且在长达40年的结肠炎病程中保持稳定，这表明无需随着时间的推移加强监测。
