Carrat F, Seksik P, Colombel J-F, Peyrin-Biroulet L, Beaugerie L
Department of Public Health, Hôpital Saint-Antoine, Hôpitaux de Paris, and Sorbonne Universités, and Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France.
Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, and Université Pierre et Marie Curie Paris 06, Paris, France.
Aliment Pharmacol Ther. 2017 Feb;45(4):533-541. doi: 10.1111/apt.13897. Epub 2016 Dec 19.
Whether aminosalicylates or thiopurines reduce the risk of colorectal cancer (CRC) in inflammatory bowel (IBD) disease is controversial.
To assess simultaneously the chemopreventive effect of aminosalicylates or thiopurines in a case-control study nested in the CESAME observational cohort that enrolled consecutive patients with IBD between May 2004 and June 2005. Patients were followed up to December 2007.
Study population comprised 144 case patients who developed CRC from the diagnosis of IBD (65 and 79 cases diagnosed, respectively, before and from 2004, starting year of the prospective observational period of CESAME) and 286 controls matched for gender, age, IBD subtype and year of diagnosis, and cumulative extent of colitis. Exposure to aminosalicylates or thiopurines was defined by an exposure to the treatment during the year of the diagnosis of cancer. The propensity of receiving 5-ASA and thiopurines was quantified by a composite score taking into account patient and IBD characteristics. The role of aminosalicylates or thiopurines was assessed by multivariate analysis. Propensity scores and the history of primary sclerosing cholangitis were entered into the multivariate model for adjustment.
By multivariate analysis adjusted for propensity, a significant protective effect of exposure to drugs during the year of cancer was found for aminosalicylates (OR = 0.587, 95% CI: 0.367-0.937, P = 0.0257), but not for thiopurines (OR = 0.762, 95% CI: 0.432-1.343, P = 0.3468).
In a case-control study nested in the CESAME cohort, a significant decrease in the risk of colorectal cancer in IBD was associated with exposure to aminosalicylates, not to thiopurines.
氨基水杨酸类药物或硫唑嘌呤是否能降低炎症性肠病（IBD）患者患结直肠癌（CRC）的风险存在争议。
在CESAME观察性队列中开展一项病例对照研究，同时评估氨基水杨酸类药物或硫唑嘌呤的化学预防效果。该队列纳入了2004年5月至2005年6月期间连续的IBD患者，并随访至2007年12月。
研究人群包括144例从IBD诊断起发生CRC的病例患者（分别有65例和79例在2004年之前及2004年起被诊断，2004年是CESAME前瞻性观察期的起始年份），以及286例按性别、年龄、IBD亚型、诊断年份和结肠炎累积范围匹配的对照。癌症诊断当年接受氨基水杨酸类药物或硫唑嘌呤治疗被定义为暴露。通过综合考虑患者和IBD特征的复合评分来量化接受5-氨基水杨酸（5-ASA）和硫唑嘌呤的倾向。通过多变量分析评估氨基水杨酸类药物或硫唑嘌呤的作用。倾向评分和原发性硬化性胆管炎病史被纳入多变量模型进行调整。
经倾向调整的多变量分析发现，癌症诊断当年暴露于药物对氨基水杨酸类药物有显著保护作用（OR = 0.587，95% CI：0.367 - 0.937，P = 0.0257），但对硫唑嘌呤无此作用（OR = 0.762，95% CI：0.432 - 1.343，P = 0.3468）。
在CESAME队列中的一项病例对照研究中，IBD患者患结直肠癌风险的显著降低与暴露于氨基水杨酸类药物有关，而非硫唑嘌呤。
