Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Am J Gastroenterol. 2013 Dec;108(12):1869-76. doi: 10.1038/ajg.2013.249. Epub 2013 Aug 27.
Population-based studies of site-specific cancer risk in patients with inflammatory bowel disease (IBD) according to IBD phenotype and treatment are lacking. We studied cancer risk in a well-characterized population-based IBD cohort from North Jutland County, Denmark.
A total of 1,515 patients were diagnosed with ulcerative colitis (UC) and 810 with Crohn's disease (CD) during 1978-2002. Patients were followed until 31 December 2010 for occurrence of incident cancer, identified in the Danish Cancer Registry. Observed numbers of cancer were compared with expected numbers (based on age- and sex-specific background rates) and presented as standardized incidence ratios (SIRs) with 95% confidence intervals (CIs).
Patients with UC were not at increased risk of cancer overall (SIR, 1.12; 95% CI, 0.97-1.28) despite increased risk of prostate cancer (SIR, 1.82; 95% CI, 1.17-2.71). Patients with CD had a 55% increased risk of cancer overall (SIR, 1.55; 95% CI, 1.29-1.84) related to young age, colonic disease, smoking, and thiopurine exposure. Patients were at increased risk of small bowel cancer (SIR, 15.18; 95% CI, 1.84-54.78), lung cancer (SIR, 2.13; 95% CI, 1.19-3.52 (associated with female gender and smoking)), colorectal cancer in males (SIR, 2.43; 95% CI, 1.05-4.78), cervical dysplasia (SIR, 1.65; 95% CI, 1.10-2.37 (associated with young age at diagnosis, smoking, 5-aminosalicylic acid, and thiopurine exposure)), and non-Hodgkin lymphoma (SIR, 3.43; 95% CI, 1.38-7.07 (unrelated to thiopurine exposure)).
Patients with CD, but not UC, have an overall excess risk of cancer. Clinical characteristics of IBD patients at excess risk differ by cancer subtype.
根据炎症性肠病（IBD）表型和治疗，对基于人群的特定部位癌症风险进行研究，目前在 IBD 患者中尚缺乏此类研究。我们研究了丹麦北日德兰郡一个特征明确的基于人群的 IBD 队列中的癌症风险。
1978 年至 2002 年间，共有 1515 例溃疡性结肠炎（UC）患者和 810 例克罗恩病（CD）患者被诊断为疾病。通过丹麦癌症登记处，对患者进行随访，直至 2010 年 12 月 31 日，以观察是否发生新诊断的癌症。观察到的癌症数量与预期数量（基于年龄和性别特定的背景率）进行比较，并以标准化发病率比（SIR）及其 95%置信区间（CI）表示。
尽管 UC 患者前列腺癌风险增加（SIR，1.82；95%CI，1.17-2.71），但总体上 UC 患者的癌症风险并无增加（SIR，1.12；95%CI，0.97-1.28）。CD 患者的总体癌症风险增加了 55%（SIR，1.55；95%CI，1.29-1.84），这与患者年龄较小、结肠疾病、吸烟和巯嘌呤暴露有关。患者小肠癌风险增加（SIR，15.18；95%CI，1.84-54.78）、肺癌风险增加（SIR，2.13；95%CI，1.19-3.52（与女性和吸烟有关））、男性结直肠癌风险增加（SIR，2.43；95%CI，1.05-4.78）、宫颈癌前病变风险增加（SIR，1.65；95%CI，1.10-2.37（与诊断时年龄较小、吸烟、5-氨基水杨酸和巯嘌呤暴露有关））和非霍奇金淋巴瘤风险增加（SIR，3.43；95%CI，1.38-7.07（与巯嘌呤暴露无关）。
CD 患者而非 UC 患者总体上存在癌症风险增加。具有额外癌症风险的 IBD 患者的临床特征因癌症亚型而异。
