溃疡性结肠炎患者的结直肠癌风险：一项基于人群的最新系统评价与Meta分析

Colorectal cancer risk in ulcerative colitis: an updated population-based systematic review and meta-analysis.

作者信息

Zhang Lechang, Zhang Xiaohua, Su Tong, Xiao Tong, Xu Hongwei, Zhao Shulei

机构信息

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

Department of Gastroenterology, Beijing Friendship Hospital Affiliated to Capital Medical University; State Key Laboratory of Digestive Health, Beijing, China.

出版信息

EClinicalMedicine. 2025 May 22;84:103269. doi: 10.1016/j.eclinm.2025.103269. eCollection 2025 Jun.

DOI:10.1016/j.eclinm.2025.103269

PMID:40496880

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12150054/

Abstract

BACKGROUND

Patients with ulcerative colitis (UC) face a heightened risk of colorectal cancer (CRC), though the estimated risk levels differ across UC populations. This study aims to provide updated, population-based estimates of CRC incidence, standardised incidence ratios (SIR), and prevalence in patients with UC.

METHODS

We searched PubMed, Embase, and Cochrane Library to April 12, 2025, for population-based studies on patients with UC reporting CRC risk. Study quality was assessed using the Newcastle-Ottawa Scale. The primary outcome was CRC risk in UC, evaluated through incidence, SIR, and prevalence. A random-effects model was used for meta-analysis, and meta-regression evaluated the impact of study characteristics. Publication bias was assessed using funnel plots and statistical tests. PROSPERO: CRD42025634800.

FINDINGS

From 7991 records, 13 population-based studies involving 161,157 patients with UC were included. Most studies were conducted in Europe, with others from North America and Asia. All studies were of good quality, with scores greater than 5 on the NOS quality assessment scale. The pooled CRC incidence was 1.47 per 1000 person-years (95% CI 1.30-1.67; I = 66.2%), the SIR was 2.48 (95% CI 1.64-3.76; I = 91.7%), and the prevalence was 1.54% (95% CI 1.14-1.99; I = 96.1%). Subgroup analyses revealed similar CRC risk in male (SIR 2.14, 95% CI 0.85-5.38) and female (SIR 2.20, 95% CI 1.52-3.19) patients and an increased risk with extensive colitis, with an SIR of 3.95 (95% CI 2.56-6.09).

INTERPRETATION

This systematic review and meta-analysis provides population-based estimates of CRC risk in patients with UC, based on high-quality studies with rigorous methodology. The results offer reliable reference values for incidence, SIR, and prevalence, which are applicable to the broader UC population and relevant to clinical decision-making and public health planning. Nonetheless, substantial heterogeneity across studies and limited geographic representation-particularly from Asia, South America, Africa, and Oceania-highlight the need for additional population-based research in underrepresented regions to improve the global applicability of CRC risk estimates in UC.

FUNDING

This study was supported by State key Laboratory of Digestive Health.

摘要

背景

溃疡性结肠炎（UC）患者患结直肠癌（CRC）的风险增加，尽管不同UC人群的估计风险水平有所不同。本研究旨在提供基于人群的UC患者CRC发病率、标准化发病率比（SIR）和患病率的最新估计。

方法

我们检索了截至2025年4月12日的PubMed、Embase和Cochrane图书馆，以查找关于报告CRC风险的UC患者的基于人群的研究。使用纽卡斯尔-渥太华量表评估研究质量。主要结局是UC患者的CRC风险，通过发病率、SIR和患病率进行评估。采用随机效应模型进行荟萃分析，荟萃回归评估研究特征的影响。使用漏斗图和统计检验评估发表偏倚。国际前瞻性系统评价注册库：CRD42025634800。

结果

从7991条记录中，纳入了13项基于人群的研究，涉及161157例UC患者。大多数研究在欧洲进行，其他研究来自北美和亚洲。所有研究质量良好，在NOS质量评估量表上的得分均大于5分。汇总的CRC发病率为每1000人年1.47例（95%CI 1.30 - 1.67；I² = 66.2%），SIR为2.48（95%CI 1.64 - 3.76；I² = 91.7%），患病率为1.54%（95%CI 1.14 - 1.99；I² = 96.1%）。亚组分析显示，男性（SIR 2.14，95%CI 0.85 - 5.38）和女性（SIR 2.20，95%CI 1.52 - 3.19）患者的CRC风险相似，广泛性结肠炎患者的风险增加，SIR为3.95（95%CI 2.56 - 6.09）。

解读

本系统评价和荟萃分析基于方法严谨的高质量研究，提供了基于人群的UC患者CRC风险估计。结果为发病率、SIR和患病率提供了可靠的参考值，适用于更广泛的UC人群，与临床决策和公共卫生规划相关。尽管如此，研究之间存在显著异质性，地理代表性有限，特别是来自亚洲、南美洲、非洲和大洋洲，这突出表明需要在代表性不足的地区进行更多基于人群的研究，以提高UC中CRC风险估计在全球的适用性。