II Department of Surgery, IV Unit, Regional Hospital Cà Foncello, Treviso, Italy.
J Gastrointest Surg. 2010 Nov;14(11):1746-51. doi: 10.1007/s11605-010-1265-0. Epub 2010 Jul 14.
Late diagnosis of cancer in CD often occurs, and the prognosis is poor. The primary aim of this study was to assess the relationship between clinical presentation and diagnosis of intestinal adenocarcinoma in CD; the secondary aim was to evaluate the timing of cancer occurrence in CD patients.
Medical records of 12 consecutive patients with intestinal adenocarcinoma in CD and of 79 consecutive CD patients undergoing bowel surgery were reviewed. Presentation symptoms were analyzed as possible predictors. Timing of intestinal adenocarcinoma occurrence in patients with CD was analyzed including all the 347 consecutive patients that had undergone surgery for CD in our institute from January 1984 to June 2008. Life table analysis and uni/multivariate analyses were performed.
Ten men and two women underwent surgery for intestinal cancer in CD with a median age of 50 years (31-68). Carcinomas were localized in the terminal ileum in four cases, right colon in three, transverse colon in one, sigmoid colon in one, rectum in two, and an anorectal fistula in one. Only three patients were pre-operatively diagnosed with cancer. At multivariate analysis only age (OR 1.057 (95% CI 0.999-1.107), p = 0.05) and obstruction (OR 6.530 (95% CI 1.533-27.806), p = 0.01) significantly predicted cancer diagnosis. The risk rate (RR) for cancer occurrence started to rise at the end of the third decade of life (RR = 0.005). The analysis of risk rate for cancer occurrence during overt CD showed that it is initially high at onset (RR = 0.001) and after two other peaks at 150 months from onset, it began to rise again. The presence of Crohn's colitis was associated to a significant risk of cancer (HR = 4.790, p = 0.009) while the use of 5-ASA resulted to be a protective factor against cancer occurrence (HR = 0.122, p = 0.013).
In CD, rectal bleeding, the most common alarm symptom for intestinal cancer, is not useful for an early diagnosis. CD patients presenting with an older age and obstruction should be thoroughly investigated to rule out neoplastic lesions. There is probably no safe interval of CD where surveillance for intestinal cancer can be omitted. In the meantime, even in absence of active disease, all CD patients should undergo therapy with 5-ASA.
CD 中癌症的诊断常常较晚，预后较差。本研究的主要目的是评估 CD 患者肠道腺癌临床表现与诊断之间的关系；次要目的是评估 CD 患者癌症发生的时间。
回顾了 12 例 CD 伴肠道腺癌和 79 例 CD 行肠道手术的连续患者的病历。分析了表现症状作为可能的预测因子。分析了我院 1984 年 1 月至 2008 年 6 月连续 347 例接受 CD 手术患者的肠道腺癌发生时间。进行生存分析和单/多变量分析。
10 名男性和 2 名女性因 CD 肠内癌接受手术，中位年龄为 50 岁（31-68 岁）。癌局限于 4 例末端回肠、3 例右结肠、1 例横结肠、1 例乙状结肠、2 例直肠、1 例直肠肛管瘘。仅 3 例患者术前诊断为癌症。多变量分析仅年龄（OR 1.057（95%CI 0.999-1.107），p=0.05）和梗阻（OR 6.530（95%CI 1.533-27.806），p=0.01）显著预测癌症诊断。癌症发生的风险率（RR）在第三十年末开始上升（RR=0.005）。分析显性 CD 期间癌症发生的风险率表明，它在发病初期（RR=0.001）和发病后另外两个高峰（150 个月后）后开始再次上升。存在克罗恩结肠炎与癌症发生的显著风险相关（HR=4.790，p=0.009），而使用 5-ASA 是癌症发生的保护因素（HR=0.122，p=0.013）。
在 CD 中，直肠出血是肠道癌症最常见的报警症状，但对早期诊断没有帮助。CD 患者出现年龄较大和梗阻时应进行彻底检查以排除肿瘤病变。CD 可能没有安全的间隔，在此期间可以省略对肠道癌症的监测。同时，即使没有活动期疾病，所有 CD 患者也应接受 5-ASA 治疗。
