Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Institute of Social and Preventive Medicine, University Hospital Lausanne-CHUV, Lausanne, Switzerland.
Am J Gastroenterol. 2019 Jan;114(1):116-126. doi: 10.1038/s41395-018-0360-9.
Malignancy may occur as long-term complication of inflammatory bowel disease (IBD) due to different risk factors. We assessed prevalence and incidence of malignancy, and predictive factors in the Swiss IBD Cohort Study (SIBDCS).
All IBD patients in the SIBDCS were analyzed from a cross-sectional and longitudinal perspective. Patients with malignancies were compared to controls. Standardized incidence ratios (SIR) were calculated based on age-specific and sex-specific background rates.
Malignancies were identified in 122 of 3119 patients (3.9%). In a logistic regression model, age (OR 1.04 per year), intestinal surgery (OR 3.34), and treatment with steroids (OR 2.10) were the main predictors for the presence of malignancy, while treatment with 5-ASA (OR 0.57) and biologics (OR 0.38) were protective. From a longitudinal perspective, 67 out of 2580 patients (2.6%) were newly diagnosed with malignancy during a follow-up of 12,420.8 years (median 4.9 years). While there was no increased risk for malignancy overall (SIR 0.93, 95% CI 0.72-1.18) and colorectal cancer (SIR 1.55, 95% CI 0.71-2.95), IBD patients had an increased risk for lymphoma (SIR 2.98, 95% CI 1.36-5.66) and biliary cancer (SIR 6.3, 95% CI 1.27-18.41). In a Cox regression model, age and recent use of immunomodulators were the main predictors for development of malignancies, while 5-ASA, biologics were protective.
IBD patients showed increased risk for lymphoma and biliary cancer, but not colorectal cancer and cancer overall. Age and recent use of immunomodulators were the main risk factors for malignancy, while aminosalicylates and biologics appear to be protective.
由于不同的风险因素，恶性肿瘤可能会作为炎症性肠病（IBD）的长期并发症发生。我们评估了瑞士炎症性肠病队列研究（SIBDCS）中恶性肿瘤的患病率、发病率和预测因素。
从横断面和纵向两个角度分析了 SIBDCS 中的所有 IBD 患者。将患有恶性肿瘤的患者与对照组进行比较。根据年龄和性别特异性背景率计算标准化发病比（SIR）。
在 3119 名患者中发现了 122 例恶性肿瘤（3.9%）。在逻辑回归模型中，年龄（每年增加 1.04）、肠道手术（OR 3.34）和皮质类固醇治疗（OR 2.10）是恶性肿瘤存在的主要预测因素，而 5-ASA 治疗（OR 0.57）和生物制剂治疗（OR 0.38）具有保护作用。从纵向角度来看，在 2580 名患者中，有 67 名（2.6%）在 12420.8 年（中位随访时间为 4.9 年）期间新诊断出恶性肿瘤。尽管总体上恶性肿瘤的风险没有增加（SIR 0.93，95%CI 0.72-1.18）和结直肠癌（SIR 1.55，95%CI 0.71-2.95），但 IBD 患者发生淋巴瘤（SIR 2.98，95%CI 1.36-5.66）和胆管癌（SIR 6.3，95%CI 1.27-18.41）的风险增加。在 Cox 回归模型中，年龄和最近使用免疫调节剂是恶性肿瘤发展的主要预测因素，而 5-ASA 和生物制剂具有保护作用。
IBD 患者发生淋巴瘤和胆管癌的风险增加，但结直肠癌和总体癌症的风险没有增加。年龄和最近使用免疫调节剂是恶性肿瘤的主要危险因素，而氨基水杨酸盐和生物制剂似乎具有保护作用。
