Gastrounit, Medical Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Gastrounit, Medical Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1117-1138.e19. doi: 10.1016/j.cgh.2020.08.015. Epub 2020 Aug 13.
BACKGROUND & AIMS: Patients with Crohn's disease (CD) and ulcerative colitis (UC) are at increased risk of developing intestinal cancer. However, less is known about the risk of extraintestinal cancers (EICs). The aim of this study was to conduct a systematic review and meta-analysis of population-based cohorts assessing the risk of EICs in inflammatory bowel disease (IBD) patients.
Only population-based studies reporting on the prevalence or incidence of EICs were included. In total, 884 studies were screened and those included were assessed for quality. Eligible studies were pooled for length of follow-up evaluation, events in the IBD population, and events or expected events in a control population for the meta-analyses.
In total, 40 studies were included in the systematic review and 15 studies were included in the meta-analysis. The overall risk of EICs was found to be increased in both CD (incidence rate ratio [IRR]: 1.43 [CI, 1.26, 1.63]) and UC (IRR: 1.15 [1.02, 1.31]) patients. Both CD and UC patients presented with an increased risk of skin (IRR: CD, 2.22 [1.41-3.48]; UC, 1.38 [1.12-1.71]) and hepatobiliary (IRR: CD, 2.31 [1.25-4.28]; UC, 2.05 [1.52-2.76]) malignancies. Furthermore, CD patients showed an increased risk of hematologic (IRR, 2.40 [1.81-3.18]) and lung (IRR, 1.53 [1.23-1.91]) cancers. These increased risks were present despite treatment with immunosuppressives.
This systematic review and meta-analysis shows that both CD and UC patients are at an increased risk of developing EICs, both overall and at specific sites. However, additional studies with longer follow-up evaluation are needed to assess the true risk of EICs posed by IBD.
克罗恩病（CD）和溃疡性结肠炎（UC）患者发生肠道癌的风险增加。然而，人们对肠外癌症（EIC）的风险知之甚少。本研究旨在对评估炎症性肠病（IBD）患者发生 EIC 风险的基于人群的队列进行系统回顾和荟萃分析。
仅纳入报告 EIC 患病率或发病率的基于人群的研究。共筛选了 884 项研究，对纳入的研究进行了质量评估。对于荟萃分析，将符合条件的研究根据随访时间评估、IBD 人群中的事件以及对照人群中的预期事件进行汇总。
本系统综述共纳入 40 项研究，荟萃分析纳入 15 项研究。结果发现，CD（发病率比 [IRR]：1.43 [95%CI，1.26，1.63]）和 UC（IRR：1.15 [1.02，1.31]）患者发生 EIC 的总体风险均增加。CD 和 UC 患者均存在皮肤（IRR：CD，2.22 [1.41-3.48]；UC，1.38 [1.12-1.71]）和肝胆（IRR：CD，2.31 [1.25-4.28]；UC，2.05 [1.52-2.76]）恶性肿瘤的风险增加。此外，CD 患者发生血液系统（IRR，2.40 [1.81-3.18]）和肺部（IRR，1.53 [1.23-1.91]）癌症的风险也增加。尽管使用了免疫抑制剂治疗，但仍存在这些风险。
本系统回顾和荟萃分析表明，CD 和 UC 患者发生 EIC 的总体风险和特定部位风险均增加。然而，需要进行随访时间更长的研究来评估 IBD 患者发生 EIC 的真实风险。
