The Dr. Henry D. Janowitz Division of Gastroenterology, The Mount Sinai School of Medicine, New York, New York 10029, USA.
Gastrointest Endosc. 2011 Nov;74(5):1087-93. doi: 10.1016/j.gie.2011.06.028. Epub 2011 Sep 10.
Emerging evidence suggests that the biology of sporadic colorectal neoplasia may differ between the proximal and distal colon. Whether such a difference exists in colitis-associated colorectal neoplasia is unknown.
To compare the rate of progression to advanced neoplasia (AN) between proximal and distal dysplasia in patients with ulcerative colitis (UC).
Retrospective cohort study.
Tertiary medical center.
From an institutional database of more than 700 patients with UC who underwent 2 or more surveillance colonoscopies between 1994 and 2006, we identified patients with extensive UC and low-grade dysplasia (LGD). Neoplasia proximal to the splenic flexure was considered proximal.
Progression to AN, defined as high-grade dysplasia (HGD) or colorectal cancer (CRC).
Among 121 patients with LGD, all 7 who progressed to CRC and 6 of 8 who progressed to HGD had distal LGD initially. Subjects with distal LGD had a significantly shorter time to progression than those with proximal LGD (P = .019); 5-year AN-free survivals for distal and proximal LGD were 75 ± 7% and 95 ± 3%, respectively (hazard ratio [HR] 5.0; 95% CI, 1.1-22.0). Additionally, flat LGD was significantly more likely to progress than raised LGD on univariate testing (HR 3.6; 95% CI, 1.3-10.1). Neither morphology nor sidedness remained significant in multivariable testing, although there was little change in the HRs (HR 2.4; 95% CI, 0.8-7.1 for morphology; HR 3.5; 95% CI, 0.7-16.8 for sidedness) in proportional hazards modeling.
Nonrandomized, retrospective trial and low incidence of AN.
In patients with long-standing, extensive UC, distal LGD is more common and progresses more rapidly to AN than proximal LGD.
新兴证据表明散发性结直肠肿瘤的生物学特性可能在近端和远端结肠之间存在差异。在炎症性肠病相关结直肠肿瘤中是否存在这种差异尚不清楚。
比较溃疡性结肠炎（UC）患者中近端和远端异型增生进展为高级别异型增生（AN）的速度。
回顾性队列研究。
三级医疗中心。
我们从一个机构数据库中选择了超过 700 名在 1994 年至 2006 年间接受了 2 次或更多次监测结肠镜检查的 UC 患者，这些患者患有广泛的 UC 和低级别异型增生（LGD）。脾曲近端的肿瘤被认为是近端肿瘤。
进展为 AN，定义为高级别异型增生（HGD）或结直肠癌（CRC）。
在 121 例 LGD 患者中，所有进展为 CRC 的 7 例和进展为 HGD 的 8 例中的 6 例最初均为远端 LGD。与近端 LGD 相比，远端 LGD 患者的进展时间明显更短（P =.019）；远端和近端 LGD 的 5 年 AN 无进展生存率分别为 75%±7%和 95%±3%（危险比[HR]5.0；95%CI，1.1-22.0）。此外，在单因素检验中，扁平 LGD 比隆起性 LGD 更有可能进展（HR 3.6；95%CI，1.3-10.1）。多变量分析中，形态或侧别均无统计学意义，但在比例风险模型中，HR 略有变化（形态的 HR 为 2.4；95%CI，0.8-7.1；侧别的 HR 为 3.5；95%CI，0.7-16.8）。
非随机、回顾性试验和 AN 发生率低。
在患有长期广泛 UC 的患者中，远端 LGD 比近端 LGD 更常见，且向 AN 进展的速度更快。
