Digestive Disease Institute, Department of Gastroenterology, The Cleveland Clinic, Cleveland, OH, USA.
J Crohns Colitis. 2012 Sep;6(8):845-51. doi: 10.1016/j.crohns.2012.01.012. Epub 2012 Feb 8.
Surveillance for colon cancer is recommended in patients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). It is unclear whether characteristics of colon neoplasia have changed over time. The aim of the study was to examine the temporal trends in colon neoplasia in patients with PSC and UC.
A total of 167 patients followed up at our institution between 1985 and 2011, 55 of these with neoplasia detected on colonoscopic biopsy were identified. Characteristics of patients with colon neoplasia in PSC-UC were studied for two different time periods: 1985-1998 (early cohort) compared to 1999-2011 (recent cohort).
The median age at diagnosis of colon neoplasms was 53 years (median IQR, 43-63). The baseline characteristics were similar in both cohorts. The colonic neoplasms that developed in PSC-UC patients were spread throughout the colon on colonoscopy, while there was predominant right sided distribution on colectomy in both cohorts. (81.7% vs. 18.3%, p<0.001) Compared to the recent cohort, both the PSC (17 vs. 11 years, p=0.02) and UC duration (20 vs. 12 years, p=0.02) were longer in the early cohort. There were no differences in the grades and stages of cancer diagnosis. In addition, no differences in transplant-free survival or UC characteristics were revealed.
With annual colonoscopic surveillance, dysplasia and cancer in patients with a combined diagnosis of PSC//UC is being diagnosed in patients with a shorter duration of these conditions. The nature and the location of neoplasia have, however, not changed.
原发性硬化性胆管炎（PSC）和溃疡性结肠炎（UC）患者推荐进行结肠癌监测。目前尚不清楚结肠癌的特征是否随时间发生了变化。本研究旨在探讨 PSC 和 UC 患者结肠癌的时间趋势。
共纳入 1985 年至 2011 年在我院接受随访的 167 例患者，其中 55 例经结肠镜活检发现有肿瘤。研究了 PSC-UC 患者的结肠癌特征在两个不同时期的变化：1985-1998 年（早期队列）与 1999-2011 年（近期队列）。
结肠肿瘤诊断的中位年龄为 53 岁（中位数 IQR，43-63）。两个队列的基线特征相似。PSC-UC 患者的结肠肿瘤在结肠镜下分布于整个结肠，而在两个队列的结肠切除术中，肿瘤主要分布于右半结肠（81.7% vs. 18.3%，p<0.001）。与近期队列相比，早期队列的 PSC（17 年 vs. 11 年，p=0.02）和 UC 病程（20 年 vs. 12 年，p=0.02）均更长。癌症的分级和分期无差异。此外，移植后无生存差异或 UC 特征无差异。
通过每年进行结肠镜监测，在 PSC//UC 联合诊断的患者中，这些疾病的病程较短，可更早诊断出异型增生和癌症。然而，肿瘤的性质和位置并未改变。
