Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), University hospitals Paris-Sud, Site de Bicêtre, Paris Sud University, Paris XI, Le Kremlin Bicêtre, France.
Inflamm Bowel Dis. 2013 Aug;19(9):1823-6. doi: 10.1097/MIB.0b013e31828c84f2.
Patients with Crohn's disease (CD) of the colon are at risk for colorectal cancer and should be screened for dysplasia and cancer of the colon. Small bowel adenocarcinoma (SBA) is a complication of small bowel CD and carries a poor prognosis. However, there is no screening test for SBA in patients with small bowel CD. The aim of this study was to assess the risk and incidence of SBA in a large prospective cohort of patients with small bowel CD and to compare it with the risk of colorectal cancer in patients with CD involving the colon, recruited in the same cohort.
In a nationwide French cohort, 11,759 patients with CD were enrolled by 680 gastroenterologists. The SBA risk was obtained by dividing the observed cases in our cohort to the expected cases in the general population.
At baseline, 8222 (69.9%) patients had small bowel CD (either alone or associated with colonic CD); their median follow-up was 35 months (interquartile range, 29-40). Five new cases of SBA were diagnosed, all in patients with small bowel CD, within inflamed areas. Among the 5 patients with incident SBA, 4 died of SBA and 1 is in remission 7 years after the diagnosis of SBA. The incidence rates of SBA were 0.235 per 1000 patient-years (95% confidence interval [CI], 0.076-0.547) among patients with small bowel CD and 0.464 per 1000 patient-years (95% CI, 0.127-1.190) among those with small bowel CD for >8 years. This accounted for approximately 30% of the risk of colorectal cancer in patients with CD of the colon. Patients with small bowel CD and small bowel CD for >8 years had an SBA standardized incidence ratio of 34.9 (95% CI, 11.3-81.5) and 46.0 (95% CI, 12.5-117.8), respectively.
SBA in patients with small bowel CD carries a poor prognosis, and its risk is approximately 30% of colorectal cancer risk in patients with CD of the colon. Further studies should determine if small bowel endoscopic screening in high-risk patients is feasible and effective.
患有结肠克罗恩病（CD）的患者存在结直肠癌的风险，应进行结直肠的异型增生和癌症筛查。小肠腺癌（SBA）是小肠 CD 的并发症，预后较差。然而，患有小肠 CD 的患者没有小肠 SBA 的筛查试验。本研究的目的是评估在一个大型前瞻性小肠 CD 患者队列中 SBA 的风险和发生率，并与在同一队列中招募的累及结肠的 CD 患者的结直肠癌风险进行比较。
在法国全国性队列中，由 680 名胃肠病学家招募了 11759 名 CD 患者。通过将我们队列中的观察病例数除以普通人群中的预期病例数来获得 SBA 风险。
基线时，8222 名（69.9%）患者患有小肠 CD（单独或与结肠 CD 相关）；他们的中位随访时间为 35 个月（四分位间距，29-40）。在 5 例新诊断的 SBA 患者中，均位于小肠 CD 受累区域。在 5 例 SBA 患者中，有 4 例死于 SBA，1 例在 SBA 诊断后 7 年处于缓解期。小肠 CD 患者的 SBA 发生率为 0.235/1000 患者年（95%置信区间，0.076-0.547），小肠 CD 持续时间＞8 年的患者为 0.464/1000 患者年（95%置信区间，0.127-1.190）。这约占结直肠 CD 患者结直肠癌风险的 30%。小肠 CD 患者和小肠 CD 持续时间＞8 年的患者 SBA 的标准化发病比分别为 34.9（95%置信区间，11.3-81.5）和 46.0（95%置信区间，12.5-117.8）。
小肠 CD 患者的 SBA 预后较差，其风险约为结直肠 CD 患者结直肠癌风险的 30%。进一步的研究应确定在高危患者中进行小肠内镜筛查是否可行且有效。
