Division of Surgery B, Sackler Faculty of Medicine, Proctology Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel.
Colorectal Dis. 2011 Nov;13(11):1230-5. doi: 10.1111/j.1463-1318.2011.02639.x.
The study assessed the clinicopathological features and survival rates of inflammatory bowel disease (IBD) patients with colorectal carcinoma (CRC), which accounts for ∼ 15% of all IBD associated death.
The medical records of patients operated on for CRC in three institutions between 1992 and 2009 were reviewed, and those with Crohn's colitis (CC) and ulcerative colitis (UC) were identified. Data on age, gender, disease duration, colitis severity, surgical procedure, tumour stage and survival were retrieved.
Fifty-three patients (40 UC and 13 CC, 27 men, mean age at operation 54 years) were found. All parameters were comparable between the groups. Mean disease duration before CRC was 22.7 years for UC and 16.6 years for CC patients (P = 0.04). CRC was diagnosed preoperatively in 43 (81%) patients. Twenty-eight patients had colon cancer, 23 had rectal cancer and two patients had more than one cancer. All malignancies were located in segments with colitis. Over one-half were diagnosed at an advanced stage (36% stage III; 17% stage IV). At a mean follow up of 56 ± 65 months, 60% were alive (54% disease free) and 40% were dead from cancer-related causes. The 5-year survival rate was 61% for the UC and 37% for the CC patients (P = NS).
CRC in IBD patients is frequently diagnosed at an advanced stage, a factor that contributes to poor prognosis. The risk of CRC in CC patients is comparable to those with UC. Long-term surveillance is recommended for patients with long-standing CC and UC.
本研究评估了炎症性肠病（IBD）患者合并结直肠癌（CRC）的临床病理特征和生存率，CRC 约占所有 IBD 相关死亡的 15%。
回顾了 1992 年至 2009 年三所机构中因 CRC 而接受手术的患者的病历，并确定了克罗恩病结肠炎（CC）和溃疡性结肠炎（UC）患者。收集了患者的年龄、性别、疾病持续时间、结肠炎严重程度、手术方式、肿瘤分期和生存数据。
共发现 53 例患者（40 例 UC 和 13 例 CC，27 例男性，手术时的平均年龄为 54 岁）。两组间所有参数均相似。UC 患者发生 CRC 前的平均疾病持续时间为 22.7 年，CC 患者为 16.6 年（P=0.04）。43 例（81%）患者术前诊断为 CRC。28 例患者患有结肠癌，23 例患有直肠癌，2 例患者患有多个癌症。所有恶性肿瘤均位于结肠炎段。超过一半的患者被诊断为晚期（36%为 III 期；17%为 IV 期）。在平均 56±65 个月的随访中，60%的患者存活（54%无疾病），40%的患者死于癌症相关原因。UC 患者的 5 年生存率为 61%，CC 患者为 37%（P=NS）。
IBD 患者的 CRC 通常在晚期诊断，这是导致预后不良的一个因素。CC 患者发生 CRC 的风险与 UC 患者相当。建议对患有长期 CC 和 UC 的患者进行长期监测。
