Department of Gastroenterology, Assistance publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
Department of Pathology, Assistance publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris, France.
Clin Gastroenterol Hepatol. 2020 Jan;18(1):150-157.e1. doi: 10.1016/j.cgh.2019.05.002. Epub 2019 May 11.
BACKGROUND & AIMS: The degree of histologic and endoscopic disease activity has been associated with an increased risk of colorectal neoplasia (CRN) in patients with inflammatory bowel diseases (IBDs), but no histologic scoring systems have been validated for determining risk of CRN. We investigated the association between histologic and endoscopic disease activity and risk of first CRN in patients with IBD who had negative findings from a surveillance colonoscopy.
We performed a retrospective analysis of consecutive patients who underwent at least 2 colonoscopies at Saint Antoine Hospital in France from January 1, 1996, through March 1, 2015, and whose first procedure was a surveillance colonoscopy. Histologic IBD activity was assessed by the Nancy histologic index. Patients were followed up for a mean 5.7 ± 3.3 years. Logistic regression and generalized estimating equations were used to identify clinical, endoscopic, and histologic factors associated with detection of neoplasia in the inflamed colon mucosa.
Among 398 patients who underwent 1277 colonoscopies, we identified 45 patients with CRN. Factors associated with CRN were primary sclerosing cholangitis (odds ratio [OR], 2.65; 95% CI, 1.06-6.61; P = .04), age (OR per 1-year increase, 1.04; 95% CI, 1.01-1.07; P = .003), and mean Nancy histologic index during follow-up evaluation (per 1-unit increase, OR, 1.69; 95% CI, 1.29-2.21; P < .001). After adjustment for established factors, chronic disease activity defined as detection of ulcerations at more than 50% of colonoscopies was not associated with an increased risk of CRN (OR, 1.24; 95% CI, 0.53-2.91; P = .62).
In addition to established risk factors, we associated Nancy histologic index scores with development of CRN. Histologic findings based on the Nancy histologic index therefore should be included in determining the risk of colonic neoplasia in patients with IBD.
组织学和内镜疾病活动程度与炎症性肠病（IBD）患者结直肠肿瘤（CRN）的风险增加相关，但尚未有组织学评分系统被验证用于确定 CRN 风险。我们研究了 IBD 患者在接受监测性结肠镜检查结果为阴性后，组织学和内镜疾病活动与首次 CRN 风险之间的关联。
我们对 1996 年 1 月 1 日至 2015 年 3 月 1 日期间在法国圣安托万医院至少进行了 2 次结肠镜检查且首次检查为监测性结肠镜检查的连续患者进行了回顾性分析。通过 Nancy 组织学指数评估 IBD 组织学活动。患者平均随访 5.7 ± 3.3 年。使用逻辑回归和广义估计方程来确定与炎症性结肠黏膜中肿瘤检出相关的临床、内镜和组织学因素。
在 398 名接受 1277 次结肠镜检查的患者中，我们发现了 45 名患有 CRN 的患者。与 CRN 相关的因素包括原发性硬化性胆管炎（OR，2.65；95%CI，1.06-6.61；P =.04）、年龄（每增加 1 岁的 OR，1.04；95%CI，1.01-1.07；P =.003）和随访期间平均 Nancy 组织学指数（每增加 1 个单位的 OR，1.69；95%CI，1.29-2.21；P <.001）。在调整了已确定的因素后，定义为结肠镜检查中超过 50%检测到溃疡的慢性疾病活动与 CRN 风险增加无关（OR，1.24；95%CI，0.53-2.91；P =.62）。
除了已确定的危险因素外，我们还将 Nancy 组织学指数评分与 CRN 的发生相关联。因此，基于 Nancy 组织学指数的组织学发现应被纳入确定 IBD 患者结直肠肿瘤风险的因素中。
