基于广泛结肠炎患者在结肠镜监测下溃疡性结肠炎的病变位置和形态，低级别异型增生进展为高级别异型增生。
Progression of low-grade dysplasia to advanced neoplasia based on the location and morphology of dysplasia in ulcerative colitis patients with extensive colitis under colonoscopic surveillance.
机构信息
Department of Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
出版信息
J Crohns Colitis. 2013 Dec;7(12):e684-91. doi: 10.1016/j.crohns.2013.06.006. Epub 2013 Jul 31.
BACKGROUND
The management of low-grade dysplasia (LGD) in ulcerative colitis (UC) patients remains unclear.
AIM
The aim of our study was to study the risk of progression of LGD to advanced neoplasia (AN), defined as high-grade dysplasia (HGD) or colorectal cancer (CRC) for UC patients undergoing surveillance based on location and morphology of LGD.
METHODS
997 UC patients underwent 3152 surveillance colonoscopies from 1998 to 2011. Kaplan-Meier estimates and incidence rates calculated.
RESULTS
Of the 102 patients with LGD (65 raised and 37 flat), 5 (4.9%) patients progressed to AN (3 HGD and 2 CRC) after a median follow-up of 36 months (interquartile range 18-71 months). Initial location of dysplasia was in the proximal colon in 47, distal colon in 55 patients. Four of the 5 (80%) patients with AN had initial dysplasia in the distal colon. Distal colonic LGD had an incidence rate for AN of 2.1 cases per 100 person years at risk, while proximal LGD had an incidence of 0.5 cases per 100 person years. Flat LGD in the distal colon was more likely to progress to AN [hazard ratio=3.6; 95% confidence interval, CI (1.3-10.6)]. Twenty of the 102 patients (15 flat and 5 raised) underwent colectomy: 2 (10%) had evidence of AN in colectomy (1 HGD and 1 CRC), 9 had LGD and remaining 9 did not have dysplasia.
CONCLUSIONS
The frequency of progression of LGD to AN is low. Flat dysplasia located in the distal colon is associated with a greater risk of progression to AN.
背景
溃疡性结肠炎（UC）低级别异型增生（LGD）的处理仍不明确。
目的
本研究旨在研究基于 LGD 位置和形态对接受监测的 UC 患者，LGD 进展为高级别异型增生（HGD）或结直肠癌（CRC）这一进展为高级别异型增生（AN）的风险。
方法
1998 年至 2011 年期间，997 例 UC 患者接受了 3152 次监测结肠镜检查。采用 Kaplan-Meier 估计和发病率计算。
结果
102 例 LGD 患者（65 例隆起型和 37 例平坦型）中，5 例（4.9%）患者在中位随访 36 个月（18-71 个月）后进展为 AN（3 例 HGD 和 2 例 CRC）。异型增生的初始位置位于近端结肠 47 例，远端结肠 55 例。5 例 AN 患者中，有 4 例（80%）的初始异型增生位于远端结肠。远端结肠 LGD 的 AN 发病率为每 100 人年 2.1 例，而近端 LGD 的发病率为每 100 人年 0.5 例。远端结肠平坦型 LGD 更易进展为 AN[风险比=3.6；95%置信区间（CI），1.3-10.6]。102 例患者中有 20 例（15 例平坦型和 5 例隆起型）接受了结肠切除术：2 例（10%）在结肠切除术中发现 AN（1 例 HGD 和 1 例 CRC），9 例有 LGD，其余 9 例无异型增生。
结论
LGD 进展为 AN 的频率较低。位于远端结肠的平坦型异型增生与进展为 AN 的风险增加相关。
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