Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.
Gut. 2019 Sep;68(9):1588-1596. doi: 10.1136/gutjnl-2018-316651. Epub 2018 Dec 15.
The rate of postcolonoscopy colorectal cancer (PCCRC) is considered a key quality indicator of colonoscopy; little is known about PCCRC in IBD.
A population-based cohort study of colonoscopies in Sweden from 2001 to 2010 was conducted. Individuals with a colorectal cancer (CRC) detected within 36 months after a colonoscopy were identified and stratified on UC, Crohn's disease (CD) or non-IBD. The CRCs were classified as detected CRCs (dCRC) (0-6 months) or as PCCRCs (6-36 months). PCCRC rates were calculated by the number of false negative/(the number of true positive+the number of false negative) colonoscopies. Poisson regression analysis was employed to examine the association between PCCRC and IBD (CD and UC) diagnosis, age, gender, location, time period and comorbidities.
We identified 348 232 colonoscopies in 270 918 individuals. Of these, 27 123 were performed on 14 597 individuals with CD, and 51 572 were performed on 26 513 individuals with UC. There were 13 317 CRCs in the non-IBD group, 133 in the CD group and 281 in the UC group. The PCCRC rate in the CD group was 28.3% and 41.0% in the UC group. The RR for a PCCRC was 3.82 (95% CI 2.94 to 4.96) in CD and 5.89 (95% CI 5.10 to 6.80) in UC, compared with non-IBD. The highest risk was observed among rectal cancer location in CD and in younger individuals with UC.
The high rates of PCCRC in young patients with UC and for rectal cancer location in CD might affect future performance of IBD surveillance.
结直肠镜检查后的结直肠癌（PCCRC）发生率被认为是结直肠镜检查的一个关键质量指标；但在炎症性肠病（IBD）中，人们对 PCCRC 知之甚少。
对 2001 年至 2010 年瑞典进行的一项基于人群的结肠镜检查队列研究进行了分析。在结肠镜检查后 36 个月内发现结直肠癌（CRC）的个体，并按溃疡性结肠炎（UC）、克罗恩病（CD）或非 IBD 进行分层。将 CRC 分为检出 CRC（dCRC）（0-6 个月）或 PCCRC（6-36 个月）。通过真阳性（true positive）+假阴性（false negative）的数量计算 PCCRC 发生率。采用泊松回归分析，检测 PCCRC 与 IBD（CD 和 UC）诊断、年龄、性别、部位、时间段和合并症之间的关系。
我们在 270918 名个体中识别出 348232 例结肠镜检查，其中 27123 例在 14597 名 CD 患者中进行，51572 例在 26513 名 UC 患者中进行。非 IBD 组有 13317 例 CRC，CD 组 133 例，UC 组 281 例。CD 组的 PCCRC 发生率为 28.3%，UC 组为 41.0%。与非 IBD 相比，CD 组的 PCCRC 比值比（RR）为 3.82（95%可信区间 2.94 至 4.96），UC 组为 5.89（95%可信区间 5.10 至 6.80）。在 CD 中，直肠癌部位和年轻的 UC 患者中观察到最高的风险。
UC 年轻患者和 CD 直肠癌症位置的 PCCRC 发生率较高，可能会影响未来 IBD 监测的表现。
