Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Tampere Medical School, University of Tampere, Tampere, Finland.
J Crohns Colitis. 2013 Dec;7(11):e551-7. doi: 10.1016/j.crohns.2013.04.003. Epub 2013 Apr 23.
Data on the relative risk of colorectal cancer in inflammatory bowel diseases (IBD) are inconsistent. To prevent the development of cancer, endoscopic facilities should be targeted correctly. We report here the results of a 20-year follow-up in Finland and evaluate the efficacy of endoscopic surveillance in cancer prevention.
The data were based on an IBD register in our catchment area in 1986-2007. The population-based cohort comprised 1915 patients, 1254 with ulcerative colitis, 550 with Crohn's disease and 111 with inflammatory bowel unclassified. Colorectal cancer cases were obtained from the IBD register; the colorectal cancer figures in the respective population were obtained from the Finnish Cancer Registry.
Colorectal cancer was found in 21 patients, the standardized incidence ratio (SIR) being 1.83 (95% confidence interval (CI) 1.13-2.79) for IBD. Colorectal cancer risk was 3.09 (CI 1.50-5.75) for extensive UC, and 3.62 (CI 2.00-11.87) for Crohn's disease affecting the colon. Eleven (52%) of the colorectal cancer cases were TNM stage 3 or 4. In the same observation period 10 colectomies with ileoanal anastomosis were performed with the indication of cancer risk in ulcerative colitis; of these 10 patients only two had no additional risk factors for colorectal cancer, for example primary sclerosing cholangitis, pseudopolyposis or active disease.
The risk of colorectal cancer in the cohort was only moderately increased. In the absence of additional risk factors, endoscopic surveillance was of limited benefit. We therefore suggest intensive endoscopy surveillance to be targeted on patients with definite risk factors.
炎症性肠病（IBD）患者发生结直肠癌的相对风险数据不一致。为了预防癌症的发生，应正确地将内镜设施用于目标人群。在此我们报告芬兰一项 20 年的随访结果，并评估内镜监测在预防癌症方面的效果。
该数据基于我们在 1986 年至 2007 年的研究区域中的 IBD 登记。该基于人群的队列包含 1915 名患者，其中 1254 名为溃疡性结肠炎，550 名为克罗恩病，111 名为未分类的炎症性肠病。结直肠癌病例来自 IBD 登记处；相应人群中的结直肠癌数据来自芬兰癌症登记处。
21 名患者被诊断为结直肠癌，标准化发病比（SIR）为 1.83（95%置信区间[CI]：1.13-2.79）。广泛性溃疡性结肠炎的结直肠癌风险为 3.09（CI：1.50-5.75），累及结肠的克罗恩病的结直肠癌风险为 3.62（CI：2.00-11.87）。11 例（52%）结直肠癌患者的 TNM 分期为 3 期或 4 期。在相同的观察期内，10 例溃疡性结肠炎患者因存在癌症风险而行回肠肛门吻合术，其中仅 2 例无其他结直肠癌的额外危险因素，例如原发性硬化性胆管炎、假性息肉或活动期疾病。
该队列的结直肠癌风险仅中度增加。在无其他危险因素的情况下，内镜监测的获益有限。因此，我们建议对有明确危险因素的患者进行强化内镜监测。
