Larsen Mette, Mose Hanne, Gislum Mette, Skriver Mette V, Jepsen Peter, Nørgård Bente, Sørensen Henrik T
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
Am J Gastroenterol. 2007 Jan;102(1):163-7. doi: 10.1111/j.1572-0241.2006.00857.x. Epub 2006 Oct 13.
Patients with Crohn's disease (CD) are at increased risk of colorectal cancer (CRC), but little is known about the impact of CD on CRC prognosis. Based on nationwide population-based registries, we compared survival among CRC patients with CD and CRC patients without CD.
We used the Danish Cancer Registry and the Danish Hospital Discharge Registry to identify all patients diagnosed with CRC, with and without CD, in Denmark between 1977 and 1999. We ascertained the stage distribution at the time of CRC diagnosis and 1- and 5-yr survival both for patients with Crohn-associated CRC and patients with non-Crohn CRC. Cox regression was used to compute hazard ratios (HRs), adjusting for gender, age, calendar year, and stage.
We identified 100 CRC patients with CD and 71,438 CRC patients without CD. At the time of diagnosis, patients with CD were younger, but stage distributions were similar in the two groups. The overall HR for CRC with CD compared to CRC without CD was 1.82 (95% CI 1.36-2.43) after 1 yr of follow-up, and 1.57 (95% CI 1.24-1.99) after 5 yr of follow-up. Subanalyses showed that the effect of CD on CRC survival was more pronounced in the youngest patients (0-59 yr), in men, and in patients whose tumors had regional spread.
We found that CD worsens the prognosis of CRC, particularly CRC with regional spread.
克罗恩病（CD）患者患结直肠癌（CRC）的风险增加，但关于CD对CRC预后的影响知之甚少。基于全国性的人群登记系统，我们比较了患有CD的CRC患者和未患CD的CRC患者的生存率。
我们使用丹麦癌症登记处和丹麦医院出院登记处，确定1977年至1999年间丹麦所有诊断为CRC的患者，包括有和没有CD的患者。我们确定了CRC诊断时的分期分布以及克罗恩相关性CRC患者和非克罗恩CRC患者的1年和5年生存率。使用Cox回归计算风险比（HR），并对性别、年龄、日历年和分期进行调整。
我们确定了100例患有CD的CRC患者和71438例未患CD的CRC患者。诊断时，患有CD的患者更年轻，但两组的分期分布相似。随访1年后，患有CD的CRC与未患CD的CRC相比，总体HR为1.82（95%CI 1.36 - 2.43），随访5年后为1.57（95%CI 1.24 - 1.99）。亚组分析显示，CD对CRC生存的影响在最年轻的患者（0 - 59岁）、男性以及肿瘤有区域扩散的患者中更为明显。
我们发现CD会恶化CRC的预后，特别是有区域扩散的CRC。
