Stolwijk J A M, Langers A M J, Hardwick J C, Veenendaal R A, Verspaget H W, van Hogezand R A, Vasen H F, van der Meulen-de Jong A E
Gastroenterology Department, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands.
ScientificWorldJournal. 2013 Nov 28;2013:274715. doi: 10.1155/2013/274715. eCollection 2013.
Patients with ulcerative colitis have an increased risk of developing colorectal cancer (CRC). The aim of this study is to assess the yield of surveillance colonoscopies in a tertiary referral cohort of ulcerative colitis patients and to identify different risk groups for dysplasia.
A cohort of 293 patients (148 males, mean age 33.8 years at diagnosis) was built up at our center and started the surveillance program 8-12 years after start of symptoms. They underwent colonoscopies every one to three years. Endpoints were dysplasia or a (sub)total colectomy.
After a follow-up period of 10 years, the cumulative incidence of any dysplasia was 23.5%, and of CRC 4.0%. After 15 years these percentages were 33.3% and 6.8%. Patients with pancolitis (n = 178) had a significantly higher cumulative risk of dysplasia than patients with distal disease, HR 1.9 (95%CI 1.1-3.3). Patients who started surveillance at an older age are at increased risk for any dysplasia, HR 1.03 (95%CI 1.01-1.05).
This prospective surveillance study shows a high yield of dysplasia in ulcerative colitis patients. We recommend developing separate surveillance programs for different risk groups. In our opinion patients with distal colitis can follow the general population surveillance program.
溃疡性结肠炎患者患结直肠癌（CRC）的风险增加。本研究的目的是评估三级转诊队列中溃疡性结肠炎患者监测性结肠镜检查的结果，并确定发育异常的不同风险组。
在我们中心建立了一个由293名患者组成的队列（148名男性，诊断时平均年龄33.8岁），在症状出现8 - 12年后开始监测计划。他们每1至3年接受一次结肠镜检查。终点是发育异常或（次）全结肠切除术。
经过10年的随访，任何发育异常的累积发生率为23.5%，结直肠癌为4.0%。15年后，这些百分比分别为33.3%和6.8%。全结肠炎患者（n = 178）发育异常的累积风险显著高于远端疾病患者，风险比（HR）为1.9（95%置信区间[CI] 1.1 - 3.3）。开始监测时年龄较大的患者发生任何发育异常的风险增加，HR为1.03（95%CI 1.01 - 1.05）。
这项前瞻性监测研究表明溃疡性结肠炎患者发育异常的检出率很高。我们建议为不同风险组制定单独的监测计划。我们认为远端结肠炎患者可以遵循一般人群的监测计划。
