Department of Medicine, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden.
Gastroenterology. 2010 May;138(5):1697-703. doi: 10.1053/j.gastro.2010.02.007. Epub 2010 Feb 16.
BACKGROUND & AIMS: Reported differences in cancer risk between male and female animals after chronic inflammation suggest that estrogen has inflammation-modifying properties. Little is known about these effects in human beings. Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC); we studied differences in inflammation-associated CRC between men and women patients with IBD.
By using a large population-based cohort (n = 7607) of individuals diagnosed with IBD from 1954 to 1989, we assessed the sex-specific incidence of CRC from 1960 to 2004. Incidence was determined within the cohort (modeled using Poisson regression) and compared with the general population (assessed as standardized incidence ratios) using data from national Swedish health and census registers.
During 171,000 person-years of follow-up evaluation, 196 new cases of CRC were observed (123 in males, 73 in females). Males with IBD had a 60% higher risk of CRC (relative risk [RR], 1.6; 95% confidence interval [CI], 1.2-2.2) than females (cumulative incidence 40 years after IBD diagnosis, 8.3% vs 3.5%). Compared with the rate of CRC among the general population, in males with IBD the RR was 2.6 and the 95% CI was 2.2-3.1, whereas in females the RR was 1.9 and the 95% CI was 1.5-2.4. The effect of sex was limited to the period after 10 years of follow-up evaluation (RR, 0.8 before vs 2.2 after), and to patients diagnosed before age 45 (RR, 2.1 before vs 1.0 after).
IBD confers a lower risk of CRC to females than to males.
据报道，慢性炎症后雄性和雌性动物的癌症风险存在差异，这表明雌激素具有炎症调节作用。目前人们对人类的这些影响知之甚少。炎症性肠病（IBD）与结直肠癌（CRC）的风险增加有关；我们研究了 IBD 患者中与炎症相关的 CRC 在男性和女性之间的差异。
通过使用一个大型基于人群的队列（n=7607），我们评估了 1954 年至 1989 年期间诊断为 IBD 的个体从 1960 年至 2004 年 CRC 的特定性别发病率。使用 Poisson 回归模型在队列内确定发病率（模型），并使用来自国家瑞典健康和人口普查登记处的数据，将发病率与普通人群（评估为标准化发病率比）进行比较。
在 171000 人年的随访评估期间，观察到 196 例新的 CRC 病例（男性 123 例，女性 73 例）。IBD 男性患 CRC 的风险比女性高 60%（相对风险 [RR]，1.6；95%置信区间 [CI]，1.2-2.2）（40 年后 IBD 诊断的累积发病率，男性为 8.3%，女性为 3.5%）。与普通人群的 CRC 发生率相比，IBD 男性的 RR 为 2.6，95%CI 为 2.2-3.1，而女性的 RR 为 1.9，95%CI 为 1.5-2.4。这种性别差异仅限于随访评估 10 年后的时期（RR，0.8 年前 vs 2.2 年后），以及诊断年龄小于 45 岁的患者（RR，2.1 年前 vs 1.0 年后）。
IBD 对女性 CRC 的风险低于男性。
