Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
Am J Gastroenterol. 2011 Feb;106(2):319-28. doi: 10.1038/ajg.2010.428. Epub 2010 Nov 2.
The risk for inflammatory bowel disease (IBD)-related colorectal cancer (CRC) remains a matter of debate. Initial reports mainly originate from tertiary referral centers, and conflict with more recent studies. Overall, epidemiology of IBD-related CRC is relevant to strengthen the basis of surveillance guidelines. We performed a nationwide nested case-control study to assess the risk for IBD-related CRC and associated prognostic factors in general hospitals.
IBD patients diagnosed with CRC between January 1990 and July 2006 in 78 Dutch general hospitals were identified as cases, using a nationwide automated pathology database. Control IBD patients without CRC were randomly selected. Clinical data were collected from detailed chart review. Poisson regression analysis was used for univariable and multivariable analyses.
A total of 173 cases were identified through pathology and chart review and compared with 393 controls. The incidence rate of IBD-related CRC was 0.04%. Risk factors for IBD-related CRC were older age, concomitant primary sclerosing cholangitis (PSC, relative ratio (RR) per year duration 1.05; 95% confidence interval (CI) 1.01-1.10), pseudopolyps (RR 1.92; 95% CI 1.28-2.88), and duration of IBD (RR per year 1.04; 95% CI 1.02-1.05). Using immunosuppressive therapy (odds ratio (OR) 0.3; 95% CI 0.16-0.56, P<0.001) or anti-tumor necrosis factor (TNF) (OR 0.09; 95% CI 0.01-0.68, P<0.02) was protective.
We found a limited risk for developing IBD-related CRC in The Netherlands. Age, duration of PSC and IBD, concomitant pseudopolyps, and use immunosuppressives or anti-TNF were strong prognostic factors in general hospitals.
炎症性肠病（IBD）相关结直肠癌（CRC）的风险仍然存在争议。最初的报告主要来自三级转诊中心，与最近的研究相冲突。总体而言，IBD 相关 CRC 的流行病学与加强监测指南的基础有关。我们进行了一项全国性的嵌套病例对照研究，以评估一般医院中 IBD 相关 CRC 的风险和相关预后因素。
使用全国性的自动病理数据库，在 78 家荷兰综合医院中确定了 1990 年 1 月至 2006 年 7 月期间诊断为 CRC 的 IBD 患者作为病例，并通过详细的图表审查选择了没有 CRC 的对照 IBD 患者。收集临床数据来自详细的图表审查。使用泊松回归分析进行单变量和多变量分析。
通过病理和图表审查共确定了 173 例病例，并与 393 例对照进行了比较。IBD 相关 CRC 的发病率为 0.04%。IBD 相关 CRC 的危险因素是年龄较大、同时患有原发性硬化性胆管炎（PSC，每增加 1 年的相对比率（RR）为 1.05；95%置信区间（CI）为 1.01-1.10）、假性息肉（RR 为 1.92；95%CI 为 1.28-2.88）和 IBD 持续时间（RR 为每年 1.04；95%CI 为 1.02-1.05）。使用免疫抑制治疗（比值比（OR）为 0.3；95%CI 为 0.16-0.56，P<0.001）或抗肿瘤坏死因子（TNF）（OR 为 0.09；95%CI 为 0.01-0.68，P<0.02）是保护性的。
我们发现荷兰 IBD 相关 CRC 的风险有限。年龄、PSC 和 IBD 的持续时间、同时存在假性息肉、使用免疫抑制剂或抗 TNF 是综合医院中的强预后因素。
