Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Inflamm Bowel Dis. 2018 Mar 19;24(4):732-741. doi: 10.1093/ibd/izx104.
Cancer and death are the most severe outcomes that affect patients with inflammatory bowel disease (IBD). These outcomes are even more severe if they occur at a young age but are rare, even in the general population. We conducted a systematic review to provide an overview of all reported pediatric (PIBD) patients with severe outcome.
A literature search identified publications that reported development of cancer or fatal outcome in PIBD patients. Studies were eligible for inclusion when (1) article written in English, (2) original data, (3) individual patient information, (4) full text available, (5) study population consisting of patients diagnosed with IBD under the age of 19 years, and (6) who developed malignancy or fatality at any point later in life.
A total of 98 included studies comprised data of 271 PIBD patients who developed cancer and/or fatal outcome at any point later in life. Meta-analysis demonstrated an increased risk for cancer in PIBD patients (pooled standardized incidence ratio 2.23, 95% CI: 1.98-2.52). The most frequent type of non-fatal cancer was lymphoma, whereas colorectal carcinomas were the most frequently reported type of fatal cancer in PIBD patients and were particularly associated with primary sclerosing cholangitis. The majority of patients with noncancer-related fatal outcomes were diagnosed with ulcerative colitis and most often died due to infectious complications or severe disease-associated complications.
The data in this review confirm that PIBD associated malignancy and mortality are rare and detailed clinical characteristics are limited. Prospective and international collaborations are needed to obtain more detailed patient-specific information, which is necessary to investigate the relationship between severe outcomes in PIBD patients and the currently used therapeutic strategies. 10.1093/ibd/izx104_video1izx104_Video5754026434001.
癌症和死亡是影响炎症性肠病（IBD）患者的最严重后果。如果这些后果发生在年轻时，情况会更加严重，但即使在普通人群中也很少见。我们进行了系统评价，以提供所有报告的儿科炎症性肠病（PIBD）患者严重后果的概述。
文献检索确定了报告 PIBD 患者发生癌症或致命后果的出版物。当（1）文章以英文书写，（2）原始数据，（3）患者个体信息，（4）全文可用，（5）研究人群由年龄在 19 岁以下诊断为 IBD 的患者组成，以及（6）在以后的任何时间点发生恶性肿瘤或死亡时，研究被认为符合纳入标准。
共有 98 项纳入研究包括 271 名 PIBD 患者的数据，这些患者在以后的任何时间点都发生了癌症和/或致命后果。荟萃分析显示 PIBD 患者发生癌症的风险增加（汇总标准化发病比 2.23，95%CI：1.98-2.52）。非致命性癌症最常见的类型是淋巴瘤，而结直肠癌是 PIBD 患者报告的最常见致命性癌症类型，特别是与原发性硬化性胆管炎相关。大多数非癌症相关致命结局患者被诊断为溃疡性结肠炎，最常见的死因是感染并发症或严重疾病相关并发症。
本综述中的数据证实，PIBD 相关的恶性肿瘤和死亡率很少见，详细的临床特征有限。需要前瞻性和国际合作以获得更详细的患者特定信息，这对于研究 PIBD 患者的严重后果与目前使用的治疗策略之间的关系是必要的。10.1093/ibd/izx104_video1izx104_Video5754026434001。
