Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Inflamm Bowel Dis. 2013 Mar-Apr;19(4):806-11. doi: 10.1097/MIB.0b013e31827feba5.
To date, there have been no studies on extraintestinal cancer in patients after ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease (IBD). The aim of this study was to evaluate the frequency and natural history of extraintestinal cancer and their risk factors in patients after IPAA for IBD.
All patients after IPAA with underlying IBD and extraintestinal neoplasia were identified from a prospectively maintained 932-case Pouchitis Registry from 2002 to 2010. The study group consisted of patients with de novo extraintestinal cancer, which developed after IPAA. Controls were those without extraintestinal cancer, who were randomly selected from the registry with a case to control ratio of 1 to 4. Thirty-one demographic and clinical data were compared between the study and control groups.
Twenty-eight patients with de novo extraintestinal cancer after IPAA were identified, with a mean duration of pouch construction of 8.2 ± 9.7 years. The cumulative frequency of de novo extraintestinal cancer in patients after IPAA for IBD was 3%, consisting of cancer of the breast (18%), kidney (14%), prostate (11%), thyroid (11%), and bladder (7%); melanoma (11%); and other cancers (28%). The mean age of the study group was 57.6 ± 10.1 years, with 16 (57%) being men; 8 (29%) were consuming tobacco, and 3 (11%) having preoperative and/or postoperative biologic use. Patient age, left-sided colitis, and duration of IBD before IPAA were significantly greater in patients in the study group than in controls (P < 0.05) in univariate analysis. Preoperative or postoperative use of biologics and a preoperative diagnosis of colonic neoplasia were not shown to be associated with extraintestinal cancer. The prevalence seemed to be increased in patients with renal cancer with the standardized prevalence ratio of 4.8 (95% confidence interval [CI], 1.6-12.2). In the logistic regression model, older age (odds ratio [OR] = 1.5; 95% CI, 1.2-1.8), left-sided colitis (OR = 12.3; 95% CI, 2.2-67.8), and chronic pouch inflammation (OR = 4.4; 95% CI, 1.5-12.9) were associated with the risk for extraintestinal cancer. The 1-year and 2-year mortality rates after cancer diagnosis were 7.1% and 10.7%, respectively. There was no difference in pouch failure rate between the 2 groups (4% versus 5%; P = 1.00).
The observed number of cases of renal cancer in patients after IPAA appeared to be greater than the expected number of cases in the general population. Older age and chronic pouch inflammation may be associated with an increased risk for extraintestinal cancer in this cohort. Biologic use is not associated with extraintestinal cancer in our population.
目前，尚无研究报道炎症性肠病（IBD）患者行回肠储袋肛管吻合术（IPAA）后的结外癌症情况。本研究旨在评估 IBD 患者行 IPAA 后结外癌症的频率、自然史及其危险因素。
从 2002 年至 2010 年前瞻性维持的 932 例 pouchitis 登记处中确定了所有患有 IBD 和结外肿瘤的 IPAA 患者。研究组包括 IPAA 后新发的结外癌症患者。对照组为无结外癌症的患者，从登记处中随机选择，病例与对照的比例为 1:4。比较了研究组和对照组之间 31 项人口统计学和临床数据。
在 IPAA 后发现 28 例新发结外癌症患者，储袋构建的平均时间为 8.2±9.7 年。IBD 患者 IPAA 后新发结外癌症的累积频率为 3%，包括乳腺癌（18%）、肾癌（14%）、前列腺癌（11%）、甲状腺癌（11%）和膀胱癌（7%）；黑色素瘤（11%）；以及其他癌症（28%）。研究组的平均年龄为 57.6±10.1 岁，其中 16 例（57%）为男性；8 例（29%）吸烟，3 例（11%）术前和/或术后使用生物制剂。在单因素分析中，研究组患者的年龄、左半结肠炎和 IBD 术前持续时间显著大于对照组（P<0.05）。术前或术后使用生物制剂和术前结直肠肿瘤诊断与结外癌症无关。在肾癌患者中，患病率似乎增加，标准化患病率比为 4.8（95%置信区间 [CI]，1.6-12.2）。在逻辑回归模型中，年龄较大（比值比 [OR] = 1.5；95%CI，1.2-1.8）、左半结肠炎（OR = 12.3；95%CI，2.2-67.8）和慢性储袋炎（OR = 4.4；95%CI，1.5-12.9）与结外癌症的风险相关。癌症诊断后的 1 年和 2 年死亡率分别为 7.1%和 10.7%。两组的储袋失败率无差异（4%与 5%；P=1.00）。
IPAA 后观察到的肾癌病例数似乎高于普通人群的预期病例数。年龄较大和慢性储袋炎可能与该队列中结外癌症的风险增加有关。在本人群中，生物制剂的使用与结外癌症无关。
