克罗恩病患者结直肠癌的癌症特征、预后及死亡率——一项2009 - 2019年丹麦全国队列研究

Cancer Characteristics, Prognoses, and Mortality of Colorectal Cancer in Patients With Crohn's Disease-A Danish Nationwide Cohort Study, 2009-2019.

作者信息

Johansen Martha Pollen, Wewer Mads Damsgaard, Krarup Peter-Martin, Burisch Johan, Nordholm-Carstensen Andreas

机构信息

Digestive Disease Center K, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.

Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.

出版信息

J Crohns Colitis. 2025 Mar 5;19(3). doi: 10.1093/ecco-jcc/jjae153.

DOI:10.1093/ecco-jcc/jjae153

PMID:39324656

Abstract

BACKGROUND AND AIMS

The aim of this study was to investigate the impact of Crohn's disease (CD) on patient and cancer characteristics and mortality in patients with colorectal cancer (CRC).

METHODS

This was a nationwide cohort study of patients diagnosed with CRC in Denmark from 1 January, 2009 to 31 December, 2019. Cancer characteristics were retrieved from the Danish Colorectal Cancer Group registry and merged with a nationwide cohort for inflammatory bowel disease. The main outcome was all-cause mortality in CRC patients with and without CD, comparing CD patients with CRC with those in the general CRC population (non-CD CRC), evaluated by adjusted Cox regression analysis and propensity score matching.

RESULTS

Of 38 077 CRC patients, 245 (0.6%) had CD. The median age at cancer diagnosis was 69 years (interquartile range [IQR]: 60-76) for CD-CRC and 71 years (IQR: 64-78) for non-CD CRC (p < 0.001). Most cancers were located in the right colon in the CD-CRC group. CD was not associated with increased all-cause mortality in the cohort overall. CD patients with colon and rectal cancers and UICC Stage III tumors had a higher mortality rate in both multivariate {hazard ratio (HR) 1.60 (95% confidence interval [95% CI], 1.13-2.27), p = 0.008} and univariate analyses (HR 1.57 [95% CI, 1.11-2.22], p = 0.011). In the propensity score-matched analysis, CD was not associated with increased mortality for colon cancer (HR 1.06 [0.82-1.36], p = 0.7) or rectal cancer (HR 1.25 [0.79-1.98], p = 0.3).

CONCLUSIONS

This nationwide study identified distinct features of colon and rectal cancers in patients with CD that have implications for the timing of diagnoses, disease course, and mortality specifically in UICC Stage III disease.

摘要

背景与目的

本研究旨在调查克罗恩病（CD）对结直肠癌（CRC）患者的患者特征、癌症特征及死亡率的影响。

方法

这是一项针对2009年1月1日至2019年12月31日在丹麦被诊断为CRC的患者的全国性队列研究。癌症特征从丹麦结直肠癌组登记处获取，并与全国性炎症性肠病队列合并。主要结局是患有和未患有CD的CRC患者的全因死亡率，通过调整后的Cox回归分析和倾向评分匹配，将患有CD的CRC患者与一般CRC人群（非CD CRC）进行比较。

结果

在38077例CRC患者中，245例（0.6%）患有CD。CD-CRC患者癌症诊断时的中位年龄为69岁（四分位间距[IQR]：60 - 76），非CD CRC患者为71岁（IQR：64 - 78）（p < 0.001）。CD-CRC组中大多数癌症位于右半结肠。总体队列中，CD与全因死亡率增加无关。患有结肠癌、直肠癌和国际抗癌联盟（UICC）III期肿瘤的CD患者在多变量分析（风险比[HR] 1.60[95%置信区间[95%CI]，1.13 - 2.27]，p = 0.008）和单变量分析（HR 1.57[95%CI，1.11 - 2.22]，p = 0.011）中死亡率均较高。在倾向评分匹配分析中，CD与结肠癌死亡率增加无关（HR 1.06[0.82 - 1.36]，p = 0.7）或直肠癌死亡率增加无关（HR 1.25[0.79 - 1.98]，p = 0.3）。