Colman Ruben J, Rubin David T
Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, IL, USA.; St. Barnabas Hospital Health System, The Bronx, NY, USA.
Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, IL, USA.
Intest Res. 2016 Jul;14(3):202-10. doi: 10.5217/ir.2016.14.3.202. Epub 2016 Jun 27.
BACKGROUND/AIMS: Ulcerative colitis (UC) patients are at greater risk for the development of colorectal neoplasia. Several individual studies have demonstrated associations between severity of histologic inflammation and colorectal neoplasia. However, a comprehensive systematic review has not been completed. We performed a systematic review and meta-analysis to explore the relationship between histologic inflammation and risk for neoplasia among available observational studies.
Three databases (EMBASE, MEDLINE and the Cochrane Library) were systematically searched. Studies were included if they included UC patients who underwent colonoscopic assessment and when histologic inflammation and colorectal neoplasia were both reported. Colorectal neoplasia rates were compared. Quantitative meta-analysis was attempted.
Four of 1,422 records found were eligible. Results from 2 case-control studies reported a 3.5-fold increased risk for colorectal neoplasia associated with a single point increase in histologic inflammation. This result was further corroborated by one cohort study that demonstrated increased hazard ratios. The second cohort study reported outcomes for patients with normal gross endoscopy, but had increased histological inflammation when neoplasia was assessed. Finally, this study reported increased risk for neoplastic progression by histological inflammation among patients who were normal by gross endoscopic evaluation. Quantitative meta-analysis was unsuccessful due to heterogeneity between study measures.
There is strong evidence that histologic inflammation among patients with UC increases the risk of colorectal neoplasia. The depth and nature of assessment of additional clinical variables was varied and may have resulted in greater outcome discrepancy. Additional study related to mechanisms of inflammation-related neoplasia and therapeutic modification is needed.
背景/目的：溃疡性结肠炎（UC）患者发生结直肠肿瘤的风险更高。多项个体研究已证明组织学炎症的严重程度与结直肠肿瘤之间存在关联。然而，尚未完成全面的系统评价。我们进行了一项系统评价和荟萃分析，以探讨现有观察性研究中组织学炎症与肿瘤发生风险之间的关系。
系统检索了三个数据库（EMBASE、MEDLINE和Cochrane图书馆）。纳入的研究需包括接受结肠镜评估的UC患者，且同时报告了组织学炎症和结直肠肿瘤情况。比较结直肠肿瘤发生率，并尝试进行定量荟萃分析。
在检索到的1422条记录中，有4条符合条件。两项病例对照研究的结果显示，组织学炎症每增加一分，结直肠肿瘤的风险增加3.5倍。一项队列研究进一步证实了这一结果，该研究显示风险比增加。第二项队列研究报告了内镜检查大体正常患者的结果，但在评估肿瘤时组织学炎症增加。最后，该研究报告了在内镜大体评估正常的患者中，组织学炎症会增加肿瘤进展的风险。由于研究指标之间存在异质性，定量荟萃分析未成功。
有强有力的证据表明，UC患者的组织学炎症会增加结直肠肿瘤的风险。对其他临床变量评估的深度和性质各不相同，这可能导致了更大的结果差异。需要开展更多与炎症相关肿瘤发生机制及治疗调整相关的研究。
