检测炎症性肠病患者结直肠癌的策略：一项 Cochrane 系统评价和荟萃分析。
Strategies for Detecting Colorectal Cancer in Patients with Inflammatory Bowel Disease: A Cochrane Systematic Review and Meta-Analysis.
机构信息
Department of Gastroenterology and Hepatology, Prince of Wales Hospital, Sydney, NSW, Australia. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada. Robarts Clinical Trials, Western University, London, ON, Canada. Cochrane Inflammatory Bowel Disease Group, Robarts Clinical Trials, London, ON, Canada. Department of Medicine, Western University, London, ON, Canada. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK. These authors contributed equally: William A. Bye and Christopher Ma.
出版信息
Am J Gastroenterol. 2018 Dec;113(12):1801-1809. doi: 10.1038/s41395-018-0354-7. Epub 2018 Oct 23.
OBJECTIVES
Patients with longstanding ulcerative colitis (UC) and colonic Crohn's disease (CD) have an increased risk of colorectal cancer (CRC). We assess the effectiveness of endoscopic surveillance in patients with inflammatory bowel disease (IBD) for diagnosing CRC and reducing CRC-related mortality.
METHODS
MEDLINE, EMBASE, and CENTRAL were searched from inception to 19 September 2016. Randomized controlled trials (RCTs), observational cohorts, or case-control studies assessing any form of endoscopic surveillance for early CRC detection were eligible for inclusion; studies without a comparison non-surveillance group were excluded. The primary outcome was rate of CRC detection. Secondary outcomes were rate of early (Duke stage A and B) versus late (Duke stage C & D) CRC detection and rate of CRC-related death. Data were pooled using fixed or random effects models based on the degree of heterogeneity; pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method.
RESULTS
Five observational studies evaluating 7199 IBD patients were included; no RCTs met criteria for inclusion. There are limited new studies evaluating this clinical question (last included study published 2014). There was a significantly higher rate of cancer detection in the non-surveillance group (3.2%, 135/4256) compared to the surveillance group (1.8%, 53/2895) (OR 0.58 (95% CI: 0.42-0.80), p < 0.001). In four pooled studies, there was a significantly lower rate of CRC-associated death in the surveillance group (8.5%, 15/176) compared to the non-surveillance group (22.3%, 79/354) (OR 0.36 (95% CI: 0.19-0.69), p = 0.002). In two pooled studies, there was a significantly higher rate of early-stage CRC detection in the surveillance group (15.5%, 17/110) compared to the non-surveillance group (7.7%, 9/117) (OR 5.40 (95% CI: 1.51-19.30), p = 0.009).
CONCLUSIONS
Colonoscopic surveillance in IBD is associated with a reduction in CRC development and CRC-associated death, as well as increased detection of early-stage CRC.
目的
患有长期溃疡性结肠炎（UC）和结肠克罗恩病（CD）的患者结直肠癌（CRC）的风险增加。我们评估了内镜监测在炎症性肠病（IBD）患者中的有效性，以诊断 CRC 并降低 CRC 相关死亡率。
方法
从建立到 2016 年 9 月 19 日，检索 MEDLINE、EMBASE 和 CENTRAL。符合纳入标准的是评估任何形式的内镜监测以早期发现 CRC 的随机对照试验（RCT）、观察性队列或病例对照研究；不包括没有对照非监测组的研究。主要结局是 CRC 的检出率。次要结局是早期（杜克分期 A 和 B）与晚期（杜克分期 C 和 D）CRC 的检出率以及 CRC 相关死亡率。根据异质性程度，使用固定或随机效应模型对数据进行汇总；使用 Mantel-Haenszel 方法计算具有 95%置信区间（CI）的汇总比值比（OR）。
结果
纳入了 5 项评估 7199 例 IBD 患者的观察性研究；没有 RCT 符合纳入标准。评估这一临床问题的新研究有限（最后一项纳入的研究发表于 2014 年）。非监测组的癌症检出率显著高于监测组（3.2%，135/4256）（OR 0.58（95%CI：0.42-0.80），p<0.001）。在 4 项汇总研究中，监测组的 CRC 相关死亡率显著低于非监测组（8.5%，15/176）（OR 0.36（95%CI：0.19-0.69），p=0.002）。在 2 项汇总研究中，监测组的早期 CRC 检出率显著高于非监测组（15.5%，17/110）（OR 5.40（95%CI：1.51-19.30），p=0.009）。
结论
IBD 患者的结肠镜监测可降低 CRC 的发生和 CRC 相关死亡率，并提高早期 CRC 的检出率。
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