Lutgens M W M D, Vleggaar F P, Schipper M E I, Stokkers P C F, van der Woude C J, Hommes D W, de Jong D J, Dijkstra G, van Bodegraven A A, Oldenburg B, Samsom M
Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
Gut. 2008 Sep;57(9):1246-51. doi: 10.1136/gut.2007.143453. Epub 2008 Mar 12.
To detect precancerous dysplasia or asymptomatic cancer, patients suffering from inflammatory bowel disease often undergo colonoscopic surveillance based on American or British guidelines. It is recommended that surveillance is initiated after 8-10 years of extensive colitis, or after 15-20 years for left-sided disease. These starting points, however, are not based on solid scientific evidence. Our aim was to assess the time interval between onset of inflammatory bowel disease (IBD) and colorectal carcinoma (CRC), and subsequently evaluate how many patients developed cancer before their surveillance was recommended to commence.
A nationwide automated pathology database (PALGA) was consulted to identify patients with IBD-associated colorectal carcinoma in seven university medical centres in The Netherlands between January 1990 and June 2006. Data were collected retrospectively from patient charts. Time intervals between onset of disease and cancer diagnosis were calculated in months.
149 patients were identified with confirmed diagnoses of IBD and CRC (ulcerative colitis n = 89/Crohn's disease n = 59/indeterminate colitis n = 1). Taking date of diagnosis as the entry point, 22% of patients developed cancer before the 8 or 15 year starting points of surveillance, and 28% if surveillance was commenced 10 or 20 years after diagnosis for extensive or left-sided disease, respectively. Using onset of symptoms to calculate the time interval, 17-22% of patients would present with cancer prior to the surveillance starting points.
These results show that the diagnosis of colorectal cancer is delayed or missed in a substantial number of patients (17-28%) when conducting surveillance strictly according to formal guidelines.
为了检测癌前发育异常或无症状癌症，患有炎症性肠病的患者常根据美国或英国指南接受结肠镜监测。建议在广泛性结肠炎发病8 - 10年后开始监测，左侧疾病则在发病15 - 20年后开始。然而，这些起始时间点并非基于确凿的科学证据。我们的目的是评估炎症性肠病（IBD）发病与结直肠癌（CRC）之间的时间间隔，随后评估在建议开始监测之前有多少患者发生了癌症。
查阅了一个全国性的自动化病理数据库（PALGA），以识别1990年1月至2006年6月期间荷兰七个大学医学中心患有IBD相关结直肠癌的患者。从患者病历中回顾性收集数据。计算疾病发病与癌症诊断之间的时间间隔（以月为单位）。
共识别出149例确诊为IBD和CRC的患者（溃疡性结肠炎n = 89/克罗恩病n = 59/未定型结肠炎n = 1）。以诊断日期为切入点，22%的患者在8年或15年的监测起始时间点之前发生了癌症，对于广泛性或左侧疾病，若分别在诊断后10年或20年开始监测，则这一比例为28%。以症状出现时间计算时间间隔，17 - 22%的患者在监测起始时间点之前就会被诊断为癌症。
这些结果表明，严格按照正式指南进行监测时，相当一部分患者（17 - 28%）的结直肠癌诊断会被延迟或漏诊。
