Ananthakrishnan Ashwin N, Cagan Andrew, Cai Tianxi, Gainer Vivian S, Shaw Stanley Y, Churchill Susanne, Karlson Elizabeth W, Murphy Shawn N, Kohane Isaac, Liao Katherine P
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts.
Clin Gastroenterol Hepatol. 2015 Feb;13(2):322-329.e1. doi: 10.1016/j.cgh.2014.07.018. Epub 2014 Jul 17.
BACKGROUND & AIMS: Crohn's disease and ulcerative colitis are associated with an increased risk of colorectal cancer (CRC). Surveillance colonoscopy is recommended at 2- to 3-year intervals beginning 8 years after diagnosis of inflammatory bowel disease (IBD). However, there have been no reports of whether colonoscopy examination reduces the risk for CRC in patients with IBD.
In a retrospective study, we analyzed data from 6823 patients with IBD (2764 with a recent colonoscopy, 4059 without a recent colonoscopy) seen and followed up for at least 3 years at 2 tertiary referral hospitals in Boston, Massachusetts. The primary outcome was diagnosis of CRC. We examined the proportion of patients undergoing a colonoscopy within 36 months before a diagnosis of CRC or at the end of the follow-up period, excluding colonoscopies performed within 6 months before a diagnosis of CRC, to avoid inclusion of prevalent cancers. Multivariate logistic regression was performed, adjusting for plausible confounders.
A total of 154 patients developed CRC. The incidence of CRC among patients without a recent colonoscopy (2.7%) was significantly higher than among patients with a recent colonoscopy (1.6%) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39-0.80). This difference persisted in multivariate analysis (OR, 0.65; 95% CI, 0.45-0.93) and was robust when adjusted for a range of assumptions in sensitivity analyses. Among patients with CRC, a colonoscopy within 6 to 36 months before diagnosis was associated with a reduced mortality rate (OR, 0.34; 95% CI, 0.12-0.95).
Recent colonoscopy (within 36 months) is associated with a reduced incidence of CRC in patients with IBD, and lower mortality rates in those diagnosed with CRC.
克罗恩病和溃疡性结肠炎与结直肠癌（CRC）风险增加相关。建议在炎症性肠病（IBD）诊断8年后开始，每隔2至3年进行一次监测结肠镜检查。然而，尚无关于结肠镜检查能否降低IBD患者CRC风险的报道。
在一项回顾性研究中，我们分析了马萨诸塞州波士顿2家三级转诊医院中6823例IBD患者（2764例近期接受过结肠镜检查，4059例未近期接受过结肠镜检查）的数据，这些患者均接受了至少3年的观察和随访。主要结局是CRC诊断。我们检查了在CRC诊断前36个月内或随访期末接受结肠镜检查的患者比例，不包括CRC诊断前6个月内进行的结肠镜检查，以避免纳入现患癌症。进行多因素逻辑回归分析，并对可能的混杂因素进行校正。
共有154例患者发生CRC。未近期接受结肠镜检查的患者中CRC发病率（2.7%）显著高于近期接受结肠镜检查的患者（1.6%）（比值比[OR]，0.56；95%置信区间[CI]，0.39 - 0.80）。这种差异在多因素分析中仍然存在（OR，0.65；95% CI，0.45 - 0.93），并且在敏感性分析中针对一系列假设进行校正后依然稳健。在CRC患者中，诊断前6至36个月内进行结肠镜检查与死亡率降低相关（OR，0.34；95% CI，0.12 - 0.95）。
近期（36个月内）结肠镜检查与IBD患者CRC发病率降低相关，且与CRC确诊患者的较低死亡率相关。
