De Cristofaro Elena, Marafini Irene, Mancone Roberto, Fiorillo Mariasofia, Franchin Martina, Mattogno Adelaide, Neri Benedetto, Zorzi Francesca, Del Vecchio Blanco Giovanna, Biancone Livia, Calabrese Emma, Giannarelli Diana, Monteleone Giovanni
Gastroenterology Unit, Policlinico Universitario Tor Vergata, Rome, Italy.
Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
J Crohns Colitis. 2025 Jan 11;19(1). doi: 10.1093/ecco-jcc/jjae115.
Post-colonoscopy colorectal cancer [PCCRC] is a colorectal cancer [CRC] diagnosed after a colonoscopy in which no cancer was detected [index colonoscopy]. Although the overall cumulative rates of PCCRC are low in both the general population and inflammatory bowel disease [IBD] patients, the overall incidence of PCCRC in IBD is greater than that documented in the general population. This study aimed to identify the index colonoscopy-related factors and patients' characteristics influencing IBD-associated PCCRC development.
We carried out an observational, retrospective study in which IBD-associated PCCRCs were diagnosed between 2010 and 2023. The PCCRC group was compared with a control cohort of IBD patients without CRC, matched 1:1 by several demographic and clinical features as well as characteristics of index colonoscopy, to minimise selection bias.
Among 61 CRCs identified, 37 [61%] were PCCRC. Twelve of the 37 [32%] PCCRC were diagnosed within 12 months after the previous negative colonoscopy, 15 [41%] within 12-36 months, and 10 [27%] within 36-60 months. In the multivariate analysis, the inadequate bowel preparation of the index colonoscopy (odds ratio [OR]: 5.9; 95% confidence interval [CI]: 11.1-31.4) and the presence of high-risk factors for CRC [OR: 24.03; 95% CI: 3.1-187.8] were independently associated with PCCRC. Conversely, prior exposure to immunosuppressors or biologics [OR: 0.17; 95% CI: 0.03-0.83] and random biopsies sampling at index colonoscopy [OR: 0.19; 95% CI: 0.04-0.85] were inversely associated with PCCRC.
More than 50% of CRCs in our population were PCCRC. PCCRCs were associated with previous inadequate cleansing and occurred more frequently in high-risk patients.
结肠镜检查后结直肠癌（PCCRC）是指在结肠镜检查（索引结肠镜检查）时未检测到癌症，但之后被诊断出的结直肠癌（CRC）。尽管在普通人群和炎症性肠病（IBD）患者中，PCCRC的总体累积发生率都较低，但IBD患者中PCCRC的总体发病率高于普通人群。本研究旨在确定与索引结肠镜检查相关的因素以及影响IBD相关PCCRC发生的患者特征。
我们进行了一项观察性回顾性研究，纳入了2010年至2023年间诊断为IBD相关PCCRC的患者。将PCCRC组与未患CRC的IBD患者对照组进行比较，根据多项人口统计学和临床特征以及索引结肠镜检查的特征进行1:1匹配，以尽量减少选择偏倚。
在确诊的61例CRC中，37例（61%）为PCCRC。37例PCCRC中，12例（32%）在先前结肠镜检查阴性后的12个月内被诊断，15例（41%）在12至36个月内被诊断，10例（27%）在36至60个月内被诊断。在多变量分析中，索引结肠镜检查肠道准备不充分（比值比[OR]：5.9；95%置信区间[CI]：11.1 - 31.4）和存在CRC高危因素（OR：24.03；95% CI：3.1 - 187.8）与PCCRC独立相关。相反，先前使用免疫抑制剂或生物制剂（OR：0.17；95% CI：0.03 - 0.83）以及索引结肠镜检查时随机活检取样（OR：0.19；95% CI：0.04 - 0.85）与PCCRC呈负相关。
我们研究人群中超过50%的CRC为PCCRC。PCCRC与先前清洁不充分有关，且在高危患者中更频繁发生。
