Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
J Crohns Colitis. 2021 Jan 13;15(1):24-34. doi: 10.1093/ecco-jcc/jjaa133.
We sought to determine the rate of progression from dysplasia to adenocarcinoma in ulcerative colitis [UC] vs Crohn's diseases [CD] and describe the risk factors unique to each.
All adult patients [≥18 years] with a known diagnosis of either UC or CD who underwent a surveillance colonoscopy between January 1, 2010 and January 1, 2020 were included.
A total of 23 751 surveillance colonoscopies were performed among 12 289 patients between January 1, 2010 and January 1, 2020; 6909 [56.2%] had a diagnosis of CD and 5380 [43.8%] had a diagnosis of UC. There were a total of 668 patients [5.4%] with low-grade dysplasia [LGD], 76 patients [0.62%] with high-grade dysplasia [HGD], and 68 patients [0.55%] with adenocarcinoma in the series; the majority of the dysplastic events were located in the right colon. Significantly more UC patients had a dysplastic event, but the rate of LGD and HGD dysplasia progression to adenocarcinoma was not significantly different in CD or UC [p = 0.682 and p = 1.0, respectively]. There was no significant difference in the rate of progression from LGD/HGD to adenocarcinoma based on random biopsies vs targeted biopsies of visible lesions [p = 0.37]. However, the rate of progression from LGD vs HGD to adenocarcinoma was significantly greater for HGD [p < 0.001].
While more UC patients were found to have neoplasia on colonoscopy, the rate of progression from LGD and HGD to adenocarcinoma was equivalent in UC and CD, suggesting that endoscopic surveillance strategies can remain consistent for all IBD patients.
我们旨在确定溃疡性结肠炎[UC]与克罗恩病[CD]中从异型增生到腺癌的进展速度，并描述每种疾病特有的危险因素。
所有在 2010 年 1 月 1 日至 2020 年 1 月 1 日期间接受监测结肠镜检查的已知患有 UC 或 CD 的成年患者[≥18 岁]均被纳入研究。
在 2010 年 1 月 1 日至 2020 年 1 月 1 日期间，对 12289 例患者进行了 23751 次监测结肠镜检查；其中 6909 例[56.2%]诊断为 CD，5380 例[43.8%]诊断为 UC。在该系列中，共有 668 例[5.4%]患者发生低级别异型增生[LGD]，76 例[0.62%]患者发生高级别异型增生[HGD]，68 例[0.55%]患者发生腺癌；大多数异型增生事件发生在右结肠。UC 患者中异型增生事件明显更多，但 CD 或 UC 中 LGD 和 HGD 异型增生进展为腺癌的比例并无显著差异[p = 0.682 和 p = 1.0，分别]。基于随机活检与可见病变的靶向活检，从 LGD/HGD 进展为腺癌的比例无显著差异[p = 0.37]。然而，从 HGD 进展为腺癌的比例显著高于从 LGD 进展为腺癌的比例[p<0.001]。
虽然在结肠镜检查中发现 UC 患者的肿瘤更多，但 UC 和 CD 中从 LGD 和 HGD 进展为腺癌的比例相同，这表明内镜监测策略可适用于所有 IBD 患者。
