Chotivitayatarakorn Peranart, Vilaichone Ratha-Korn
Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand.
National Gastric Cancer and Gastrointestinal Diseases Research Center, Pathumthani, Thailand. Email:
Asian Pac J Cancer Prev. 2017 Aug 27;18(8):2123-2126. doi: 10.22034/APJCP.2017.18.8.2123.
Background: Ulcerative colitis(UC) is important risk factor of colorectal cancer. Many evidences from western countries confirmed this relationship but limited studies were reported in ASEAN. This study was aimed to investigate prevalence, clinical presentations, endoscopic findings, histopathology, disease progression and risk for colorectal cancer(CRC) of UC patients in Thailand. Methods: We conducted a retrospective cohort study using computer data base from Thammasat University Hospital, Pathumthani, Thailand between September 2011 and December 2015, follow-up through May 2016. Diagnosis of UC was confirmed by histopathology and whole clinical course. Results: We identified 6,082 patients who diagnosed with colitis during the study period. Of whom, only 22 patients(<1%) was confirmed of UC. Male to female ratio was 13:9 (mean age of 47.2 years). Clinical presentations were bloody diarrhea in 86.4%, watery diarrhea in 31.8% and abdominal pain in 59.1%. According to Montreal classification, disease extensions were ulcerative proctitis in 22.7%, distal UC in 50%, and pancolitis in 27.3%. Disease grading was mild in 31.8%, moderate in 9.1%, and severe in 59.1%. The prevalence of precancerous lesions were 2/22 patients(9.1%). There was no definite invasive colorectal cancer patient during study period. However, history of malnutrition was significantly higher in patients with dysplasia than those without dysplastic lesions(50%vs.0%, P-value=0.045). There was no difference in duration and disease extension between 2 groups. Interestingly, subgroup analysis demonstrated that pancolitis was significantly more common in female than male (55.6%vs.7.7%,P-value=0.02,OR=15.0, 95%CI=1.3- 169.9). Furthermore, patients’ age> 35 years had significantly more severe colitis than younger group (81.25%vs.0%, P-value=0.0006) Conclusions: Although UC is rare disease in ASEAN, precancerous lesions for CRC were not uncommon. UC with pancolitis was common in female whereas severe colitis was common in elderly patients. Proper screening program and careful surveillance for precancerous lesions in patients at risk might be appropriate approach for early detection and improvement the treatment outcome.
溃疡性结肠炎（UC）是结直肠癌的重要危险因素。西方国家的许多证据证实了这种关系，但东盟地区的相关研究报道较少。本研究旨在调查泰国UC患者的患病率、临床表现、内镜检查结果、组织病理学、疾病进展及患结直肠癌（CRC）的风险。方法：我们进行了一项回顾性队列研究，使用泰国法政大学医院2011年9月至2015年12月的计算机数据库，并随访至2016年5月。UC的诊断通过组织病理学和整个临床病程来确认。结果：我们确定了在研究期间被诊断为结肠炎的6082例患者。其中，仅22例（<1%）被确诊为UC。男女比例为13:9（平均年龄47.2岁）。临床表现为便血腹泻占86.4%，水样腹泻占31.8%，腹痛占59.1%。根据蒙特利尔分类，疾病范围为溃疡性直肠炎占22.7%，远端UC占50%，全结肠炎占27.3%。疾病分级为轻度占31.8%，中度占9.1%，重度占59.1%。癌前病变的患病率为2/22例患者（9.1%）。研究期间无明确的浸润性结直肠癌患者。然而，发育异常患者的营养不良史显著高于无发育异常病变的患者（50%对0%，P值=0.045）。两组之间的病程和疾病范围无差异。有趣的是，亚组分析表明，全结肠炎在女性中比男性更常见（55.6%对7.7%，P值=0.02，OR=15.0，95%CI=1.3 - 169.9）。此外，年龄>35岁的患者比年轻组有更严重的结肠炎（81.25%对0%，P值=0.0006）结论：尽管UC在东盟地区是罕见疾病，但CRC的癌前病变并不少见。全结肠炎型UC在女性中常见，而重度结肠炎在老年患者中常见。对有风险的患者进行适当的筛查计划和对癌前病变进行仔细监测可能是早期发现和改善治疗结果的合适方法。
