炎症性肠病与小肠癌风险：来自丹麦和瑞典的一项基于人群的两国队列研究。

Inflammatory bowel disease and risk of small bowel cancer: a binational population-based cohort study from Denmark and Sweden.

机构信息

Inflammatory Bowel Disease Center at NYU Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York, USA

Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

出版信息

Gut. 2021 Feb;70(2):297-308. doi: 10.1136/gutjnl-2020-320945. Epub 2020 May 30.

DOI:10.1136/gutjnl-2020-320945

PMID:32474410

Abstract

OBJECTIVE

Crohn's disease (CD) is associated with increased risk of small bowel cancer (SBC), but previous studies have been small. We aimed to examine the risk of incident SBC and death from SBC in patients with inflammatory bowel disease (IBD).

DESIGN

In a binational, population-based cohort study from Sweden and Denmark of patients with IBD during 1969-2017 and matched reference individuals from the general population, we evaluated the risk of incident SBC and death from SBC. Cox regression was used to estimate adjusted hazard ratios (aHRs).

RESULTS

We identified 161 896 individuals with IBD (CD: 47 370; UC: 97 515; unclassified IBD: 17 011). During follow-up, 237 cases of SBC were diagnosed in patients with IBD (CD: 24.4/100 000 person-years; UC: 5.88/100 000 person-years), compared with 640 cases in reference individuals (2.81/100 000 person-years and 3.32/100 000 person-years, respectively). This corresponded to one extra case of SBC in 385 patients with CD and one extra case in 500 patients with UC, followed up for 10 years. The aHR for incident SBC was 9.09 (95% CI 7.34 to 11.3) in CD and 1.85 (95% CI 1.43 to 2.39) in UC. Excluding the first year after an IBD diagnosis, the aHRs for incident SBC decreased to 4.96 in CD and 1.69 in UC. Among patients with CD, HRs were independently highest for recently diagnosed, childhood-onset, ileal and stricturing CD. The relative hazard of SBC-related death was increased in both patients with CD (aHR 6.59, 95% CI 4.74 to 9.15) and patients with UC (aHR 1.57; 95% CI 1.07 to 2.32).

CONCLUSION

SBC and death from SBC were more common in patients with IBD, particularly among patients with CD, although absolute risks were low.

摘要

目的

克罗恩病（CD）与小肠癌（SBC）风险增加相关，但既往研究规模较小。本研究旨在评估炎症性肠病（IBD）患者中 SBC 发病和 SBC 死亡的风险。

设计

本研究为来自瑞典和丹麦的两国人群队列研究，纳入 1969 年至 2017 年间的 IBD 患者和来自普通人群的匹配对照个体，评估 SBC 发病和 SBC 死亡的风险。采用 Cox 回归估计校正后的危险比（aHR）。

结果

共纳入 161896 名 IBD 患者（CD：47370 例；UC：97515 例；未分类 IBD：17011 例）。随访期间，IBD 患者中诊断出 237 例 SBC（CD：24.4/100000 人年；UC：5.88/100000 人年），而对照个体中分别为 640 例（分别为 2.81/100000 人年和 3.32/100000 人年）。这相当于每 385 例 CD 患者和每 500 例 UC 患者随访 10 年就会额外出现 1 例 SBC。CD 患者的 SBC 发病 aHR 为 9.09（95%CI 7.34 至 11.3），UC 患者的 aHR 为 1.85（95%CI 1.43 至 2.39）。排除 IBD 诊断后 1 年内的患者，CD 患者的 SBC 发病 aHR 降至 4.96，UC 患者的 aHR 降至 1.69。在 CD 患者中，新诊断、儿童发病、回肠和狭窄型 CD 的 SBC 发病 HR 最高。CD（aHR 6.59，95%CI 4.74 至 9.15）和 UC（aHR 1.57；95%CI 1.07 至 2.32）患者的 SBC 相关死亡的相对危险度均增加。