Young Edward, Lawrence Matthew, Thomas Michelle, Andrews Jane
Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, IBD Service Royal Adelaide Hospital Adelaide South Australia Australia.
Colorectal Surgery Unit Royal Adelaide Hospital Adelaide South Australia Australia.
JGH Open. 2019 May 14;3(6):513-517. doi: 10.1002/jgh3.12193. eCollection 2019 Dec.
Gastrointestinal (GI) adenocarcinoma, especially colorectal cancer (CRC), is a devastating complication of inflammatory bowel disease (IBD). We sought to examine the role of chronic inflammation and other possible predictors of the development of CRC, as well as assess as yet unexamined factors such as psychological comorbidity and engagement in care.
This study included all patients involved in a tertiary hospital IBD service diagnosed with CRC between 2007 and 2017. Reports from histological specimens were assessed, and all those with adenocarcinoma, high-grade dysplasia (HGD), or multifocal low-grade dysplasia (LGD) originating within IBD-affected mucosa were included in the study.
A total of 32 patients were included in the study (17 with adenocarcinoma and 15 with HGD/multifocal LGD). The majority had a duration of disease >20 years. Eleven patients (34%, CI 20-52%) had previous disease-related surgery, and 16 (50%, CI 34-66%) had multiple previous disease-related admissions. Thirteen patients (62%, CI 41-79%) had >50% of CRP results higher than 8 mg/L. Psychiatric comorbidities were common, with 19 patients (59%, CI 42-74%) having a psychiatric comorbidity or poor engagement in treatment.
In this cohort, we have highlighted poor engagement, hesitation to up-titrate therapy when indicated, and psychological comorbidities as likely contributors to poor disease control and development of GI adenocarcinoma. Based on our data, these easily identifiable clinical care factors should not be overlooked when addressing IBD-related GI malignancy prevention. Additional research is required to assess a direct causal relationship, but this study would support the incorporation of psychology services into IBD clinics.
胃肠道腺癌，尤其是结直肠癌（CRC），是炎症性肠病（IBD）的一种严重并发症。我们试图研究慢性炎症在CRC发生中的作用以及其他可能的预测因素，并评估尚未研究的因素，如心理合并症和治疗参与度。
本研究纳入了2007年至2017年间在一家三级医院IBD服务中心被诊断为CRC的所有患者。对组织学标本报告进行评估，所有起源于IBD受累黏膜的腺癌、高级别异型增生（HGD）或多灶性低级别异型增生（LGD）患者均纳入研究。
本研究共纳入32例患者（17例腺癌患者和15例HGD/多灶性LGD患者）。大多数患者病程>20年。11例患者（34%，可信区间20 - 52%）曾接受与疾病相关的手术，16例患者（50%，可信区间34 - 66%）曾多次因疾病相关入院。13例患者（62%，可信区间41 - 79%）超过50%的C反应蛋白（CRP）结果高于8 mg/L。精神合并症很常见，19例患者（59%，可信区间42 - 74%）存在精神合并症或治疗参与度低的情况。
在这个队列中，我们强调了治疗参与度低、在有指征时不愿增加治疗剂量以及心理合并症可能是导致疾病控制不佳和胃肠道腺癌发生的因素。基于我们的数据，在预防IBD相关的胃肠道恶性肿瘤时，这些易于识别的临床护理因素不应被忽视。需要进一步研究来评估直接因果关系，但本研究支持将心理服务纳入IBD诊所。
