Forlemu Arnold N, Nana Sede Mbakop Raissa, Aslam Shehroz, Ansari Zaid, Srinivasan Indu, Chuang Keng-Yu
Internal Medicine/Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, USA.
Gastroenterology, Universite De Rennes 1, Rennes, FRA.
Cureus. 2022 Aug 2;14(8):e27599. doi: 10.7759/cureus.27599. eCollection 2022 Aug.
Introduction The risk of inflammatory bowel disease-associated colorectal cancer (IBD-CRC) is known to increase with primary sclerosing cholangitis (PSC) and a family history of CRC. However, the impact of comorbidities such as liver disease, obesity, diabetes, chronic lung, heart, and renal disease, and psychiatric illness on the risk of IBD-CRC remains unclear. We evaluated the effect of these comorbidities on the risk of IBD-CRC. Methods A retrospective review from 2009 to 2014 was conducted using the National Inpatient Sample data for adults 18 years and older. Patients with IBD (360,892), of whom 2,831 had CRC were identified using the International Classification of Diseases, Ninth Revision codes (ICD-9). Data on comorbidities were also obtained. Adjusted odds ratios (aOR) and confidence intervals (CI) were computed via logistic regression to evaluate the effect of comorbidities on the risk of IBD-CRC; the p-value was set at <0.05. Results The mean age of IBD patients in this study was 52.36±0.03. A majority of the patients with IBD-CRC were white and were significantly older compared to those without cancer (60 vs 52 years, p<0.05). The risk of colon cancer in IBD was increased by having a non-cholestatic liver disease (aOR 1.51, CI 1.23-1.86, p<0.01). Also, patients younger than 50 years with liver disease were at an increased risk of IBD-associated colon cancer in comparison to older patients (aOR 1.83 vs 1.34, p<0.05). Notably, diabetes, chronic pulmonary disease, renal failure, psychiatric illnesses, and rheumatoid diseases, were inversely associated with the risk of IBD-CRC (p<0.05). After stratifying by IBD subtypes, non-cholestatic liver disease was still independently associated with a higher risk for colon cancer in patients with ulcerative colitis or Crohn's disease (ulcerative colitis: aOR 1.43, CI 1.08-1.89; Crohn's disease: aOR 1.46, CI 1.10-2.00). Conclusions Patients with IBD who have non-cholestatic liver disease might have a higher risk for colon cancer, even at a younger age. These patients may require close colon cancer surveillance.
引言 已知炎症性肠病相关结直肠癌（IBD-CRC）的风险会随着原发性硬化性胆管炎（PSC）和结直肠癌家族史而增加。然而，诸如肝病、肥胖、糖尿病、慢性肺病、心脏病、肾病以及精神疾病等合并症对IBD-CRC风险的影响仍不明确。我们评估了这些合并症对IBD-CRC风险的影响。方法 使用2009年至2014年18岁及以上成年人的全国住院患者样本数据进行回顾性研究。利用国际疾病分类第九版编码（ICD-9）识别出IBD患者（360,892例），其中2,831例患有CRC。还获取了合并症的数据。通过逻辑回归计算调整后的比值比（aOR）和置信区间（CI），以评估合并症对IBD-CRC风险的影响；p值设定为<0.05。结果 本研究中IBD患者的平均年龄为52.36±0.03岁。与无癌症的患者相比，IBD-CRC患者大多数为白人且年龄显著更大（60岁对52岁，p<0.05）。患有非胆汁淤积性肝病会增加IBD患者患结肠癌的风险（aOR 1.51，CI 1.23 - 1.86，p<0.01）。此外，与老年患者相比，年龄小于50岁的肝病患者患IBD相关结肠癌的风险增加（aOR 1.83对1.34，p<0.05）。值得注意的是，糖尿病、慢性肺病、肾衰竭、精神疾病和类风湿疾病与IBD-CRC风险呈负相关（p<0.05）。按IBD亚型分层后，非胆汁淤积性肝病在溃疡性结肠炎或克罗恩病患者中仍与较高的结肠癌风险独立相关（溃疡性结肠炎：aOR 1.43，CI 1.08 - 1.89；克罗恩病：aOR 1.46，CI 1.10 - 2.00）。结论 患有非胆汁淤积性肝病的IBD患者可能患结肠癌的风险更高，即使在年轻时也是如此。这些患者可能需要密切的结肠癌监测。
