Harlos C H, Singh H, Nugent Z, Demers A, Mahmud S M, Czaykowski P M
Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba.
Department of Medical Oncology and Hematology, CancerCare Manitoba; Section of Gastroenterology, Department of Internal Medicine, University of Manitoba; Community Health Sciences, University of Manitoba and.
Curr Oncol. 2016 Dec;23(6):391-397. doi: 10.3747/co.23.3304. Epub 2016 Dec 21.
The data about whether patients with a prior urothelial cancer (uca) are at increased risk of colorectal cancer (crc) are conflicting. We used a competing risks analysis to determine the risk of crc after uca.
Historical cohorts were assembled by record linkage of Manitoba Cancer Registry and Manitoba Health databases. The incidence of crc for individuals with uca as their first cancer between 1987 and 2009 was compared with the incidence for randomly selected age-and sex-matched individuals without a cancer diagnosis at the index date (uca diagnosis date). Three competing outcomes (crc, another primary cancer, and death) were evaluated by competing risks proportional hazards models with adjustment for relevant confounders.
The cohorts of 4591 patients with uca and 22,312 without uca were followed for a total of 179,287 person-years (py). After uca, the rate of subsequent colon cancer in uca patients was 4.5 per 1000 py compared with 3.6 per 1000 py in the non-cancer cohort. In the multivariable analysis, no overall increase in crc risk was observed for patients first diagnosed with uca (hazard ratio: 0.88; 95% confidence interval: 0.70 to 1.1; = 0.26).
Because of similar crc risk, a similar crc screening strategy should be applied for individuals with and without uca.
关于既往患有尿路上皮癌（uca）的患者患结直肠癌（crc）风险是否增加的数据存在矛盾。我们使用竞争风险分析来确定uca后发生crc的风险。
通过马尼托巴癌症登记处和马尼托巴健康数据库的记录链接组建历史队列。将1987年至2009年间以uca作为首个癌症的个体的crc发病率与在索引日期（uca诊断日期）随机选择的无癌症诊断的年龄和性别匹配个体的发病率进行比较。通过竞争风险比例风险模型评估三种竞争结局（crc、另一种原发性癌症和死亡），并对相关混杂因素进行调整。
4591例uca患者和22312例无uca患者的队列共随访了179287人年（py）。uca后，uca患者后续结肠癌的发生率为每1000人年4.5例，而非癌症队列中为每1000人年3.6例。在多变量分析中，首次诊断为uca的患者未观察到crc风险总体增加（风险比：0.88；95%置信区间：0.70至1.1；P = 0.26）。
由于crc风险相似，对于有和没有uca的个体应采用相似的crc筛查策略。
