炎症性肠病伴异型增生不确定的黏膜患者结直肠肿瘤的风险。

Risk for colorectal neoplasia in patients with inflammatory bowel disease and mucosa indefinite for dysplasia.

机构信息

*Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio; †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and Departments of ‡Colorectal Surgery, and §Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

出版信息

Inflamm Bowel Dis. 2015 Feb;21(2):378-84. doi: 10.1097/MIB.0000000000000286.

DOI:10.1097/MIB.0000000000000286

PMID:25569733

Abstract

BACKGROUND

The management of colonic epithelial changes indefinite for dysplasia (IND) in patients with inflammatory bowel disease (IBD) remains controversial because of a paucity of published outcome data.

METHODS

We analyzed data from 93 patients with IBD who were IND and 52 IBD patients without dysplasia (controls) from the Department of Anatomic Pathology database at the Cleveland Clinic from 1989 to 2004. Pathology reports, histologic slides, clinical features, and outcomes were reviewed.

RESULTS

Twenty-two patients (23.7%) had surgical resections within 6 months of the IND assignment; of these, 6 had dysplasia (27.3%; 1 low-grade dysplasia and 5 high-grade dysplasia [HGD]). The remaining 71 patients received regular colonoscopy examinations for a mean period of 98.6 months; 18 patients developed dysplasia or carcinoma (25.2%; 10 low-grade dysplasia, 5 HGD, and 3 colorectal cancer). There was a mean interval of 53.9 months between an IND assignment and identification of dysplasia or carcinoma. Histology review of 59 cases revealed 3.2 cases per 100 person-years for neoplasia (low-grade dysplasia, HGD, or colorectal cancer) and 1.5 cases per 100 person-years for advanced neoplasia (HGD or colorectal cancer); these values were higher than those for controls (1.9 cases per 100 person-years for neoplasia and 0.7 cases per 100 person-years for advance neoplasia; P = 0.1 and P = 0.2, respectively, for IND versus controls). Patients aged more than 44 years when they were found to be IND were more likely than younger patients to develop neoplasia (hazard ratio, 6.7; P = 0.01).

CONCLUSIONS

Patients with IBD and IND are at significant risk for colorectal dysplasia and cancer. These patients should be closely followed.

摘要

背景

由于缺乏发表的结果数据，炎性肠病（IBD）患者结直肠上皮异型增生（IND）的处理仍存在争议。

方法

我们分析了 1989 年至 2004 年克利夫兰诊所解剖病理学数据库中 93 例 IBD 患者的 IND 和 52 例无异型增生（对照）的 IBD 患者的数据。对病理报告、组织学切片、临床特征和结果进行了回顾。

结果

22 例患者（23.7%）在 IND 诊断后 6 个月内接受了手术切除；其中 6 例有异型增生（27.3%；1 例低级别异型增生，5 例高级别异型增生[HGD]）。其余 71 例患者接受了常规结肠镜检查，平均随访时间为 98.6 个月；18 例患者发生异型增生或癌（25.2%；10 例低级别异型增生，5 例 HGD，3 例结直肠癌）。从 IND 诊断到发现异型增生或癌的平均间隔时间为 53.9 个月。对 59 例病例的组织学复习显示，每 100 人年发生肿瘤（低级别异型增生、HGD 或结直肠癌）的病例为 3.2 例，每 100 人年发生高级别肿瘤（HGD 或结直肠癌）的病例为 1.5 例；这些值高于对照组（每 100 人年发生肿瘤的病例为 1.9 例，发生高级别肿瘤的病例为 0.7 例；P = 0.1 和 P = 0.2，IND 与对照组相比）。IND 时年龄大于 44 岁的患者比年龄较小的患者更有可能发生肿瘤（危险比，6.7；P = 0.01）。