Calderwood Audrey H, Huo Dezheng, Rubin David T
Department of Medicine, Section of Gastroenterology, The University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Arch Intern Med. 2008 May 12;168(9):1003-9. doi: 10.1001/archinte.168.9.1003.
Different types of urologic cancers have been associated with colorectal cancer (CRC) in hereditary nonpolyposis CRC, but it is still unknown whether there is an association between urologic cancer and CRC in the general population. We sought to quantify the risk for CRC after urologic cancer and the risk for urologic cancer after CRC in patients without known genetic syndromes.
We performed a retrospective cohort analysis of the Surveillance, Epidemiology, and End Results program database from 1973 to 2000. Standard incidence ratios (SIRs) of observed to expected cases of invasive CRC were calculated for each urologic cancer site based on age, sex, ethnicity, and calendar year of diagnosis. Similar analysis was performed to determine the SIRs of urologic cancers in patients with previous CRC.
Overall, the risk for CRC was increased among patients with previous ureteral cancer (SIR, 1.80; 95% confidence interval [CI], 1.46-2.20) and renal pelvis cancer (SIR, 1.44; 95% CI, 1.20-1.72). This risk was greatest among patients who received the diagnosis of renal pelvis or ureteral cancer before the age of 60 years. There was a minimal increased risk for subsequent CRC in patients with bladder or renal parenchymal cancer. Overall, the risk for urologic cancer was increased after a diagnosis of CRC (SIR, 1.24; 95% CI, 1.20-1.28), with the highest risk for subsequent renal pelvis and ureteral cancers in patients with a CRC diagnosis before the ages of 50 to 60 years or multiple primary CRCs.
Previous renal pelvis and ureteral cancers, particularly when diagnosed at an early age, increase the risk for subsequent CRC. Likewise, a history of CRC, especially in cases with multiple primary tumors, is associated with an increased risk of renal pelvis and ureteral cancers. These findings support a possible common pathogenetic mechanism between CRC and urologic cancers and may have implications for screening guidelines.
在遗传性非息肉病性结直肠癌中，不同类型的泌尿系统癌症与结直肠癌（CRC）相关，但在普通人群中，泌尿系统癌症与CRC之间是否存在关联仍不清楚。我们试图量化无已知遗传综合征患者在患泌尿系统癌症后患CRC的风险以及患CRC后患泌尿系统癌症的风险。
我们对1973年至2000年的监测、流行病学和最终结果计划数据库进行了回顾性队列分析。根据年龄、性别、种族和诊断年份，计算每个泌尿系统癌症部位侵袭性CRC的观察病例与预期病例的标准发病率比（SIR）。进行了类似分析以确定既往患CRC患者中泌尿系统癌症的SIR。
总体而言，既往患输尿管癌（SIR，1.80；95%置信区间[CI]，1.46 - 2.20）和肾盂癌（SIR，1.44；95%CI，1.20 - 1.72）的患者患CRC的风险增加。这种风险在60岁之前被诊断为肾盂或输尿管癌的患者中最大。膀胱或肾实质癌患者后续患CRC的风险略有增加。总体而言，CRC诊断后泌尿系统癌症的风险增加（SIR，1.24；95%CI，1.20 - 1.28），在50至60岁之前诊断为CRC或患有多个原发性CRC的患者中，后续肾盂和输尿管癌的风险最高。
既往肾盂和输尿管癌，尤其是在早年诊断时，会增加后续患CRC的风险。同样，CRC病史，尤其是在有多个原发性肿瘤的情况下，与肾盂和输尿管癌风险增加相关。这些发现支持CRC与泌尿系统癌症之间可能存在共同致病机制，可能对筛查指南有影响。
