Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Gastrointest Endosc. 2017 Jul;86(1):93-104.e5. doi: 10.1016/j.gie.2016.12.009. Epub 2016 Dec 21.
The risk of colorectal cancer (CRC) in various chronic liver diseases compared with the general population remains unclear. We performed a systematic review and meta-analysis to assess the risk of CRC in patients with chronic liver diseases before and after liver transplantation.
Electronic databases were searched for studies assessing the risk of CRC in patients with chronic liver diseases. The primary outcome was the pooled risk of CRC among studies that reported the risk as standardized incidence rate (SIR).
Fifty studies that included 55,991 patients were identified. Among studies that included hepatitis and cirrhotic patients, the pooled SIR was 2.06 (P < .0001; 95% confidence interval (CI), 1.46-2.90) with moderate heterogeneity (I = 49.2%), which appeared to be because of the difference between subgroup of diseases and the power of studies. Three studies reported an increased risk of CRC in primary sclerosing cholangitis patients (pooled SIR 6.70; P < .0001; 95% CI, 3.48-12.91) with moderate heterogeneity (I = 36.3%), which appeared to be because of the difference between the power of studies. Among studies that included post-transplant patients, the pooled SIR was 2.16 (P < .0001; 95% CI, 1.59-2.94) with moderate heterogeneity (I = 56.4%). Meta-regression showed a correlation between the proportion of autoimmune-related liver diseases and the risk of CRC.
Patients with chronic liver diseases had an increased risk of CRC compared with the general population, which persisted after liver transplantation. A more intensive surveillance for CRC is warranted in this population.
各种慢性肝病患者罹患结直肠癌（CRC）的风险与普通人群相比尚不清楚。我们进行了一项系统评价和荟萃分析，以评估慢性肝病患者在肝移植前后发生 CRC 的风险。
检索电子数据库以评估评估慢性肝病患者发生 CRC 风险的研究。主要结局是报告风险作为标准化发病比（SIR）的研究中 CRC 的汇总风险。
共确定了 50 项纳入 55991 例患者的研究。在纳入肝炎和肝硬化患者的研究中，SIR 汇总值为 2.06（P<0.0001；95%置信区间（CI），1.46-2.90），存在中度异质性（I²=49.2%），这似乎是由于疾病亚组之间的差异和研究的效能不同所致。三项研究报告原发性硬化性胆管炎患者 CRC 的风险增加（SIR 汇总值为 6.70；P<0.0001；95%CI，3.48-12.91），存在中度异质性（I²=36.3%），这似乎是由于研究效能的差异所致。纳入肝移植后患者的研究中，SIR 汇总值为 2.16（P<0.0001；95%CI，1.59-2.94），存在中度异质性（I²=56.4%）。Meta 回归显示，自身免疫性相关肝病的比例与 CRC 的风险之间存在相关性。
与普通人群相比，慢性肝病患者发生 CRC 的风险增加，在肝移植后仍持续存在。在这一人群中，需要更加强化 CRC 的监测。
