Broomé U, Löfberg R, Veress B, Eriksson L S
Unit of Gastroenterology and Hepatology, Karolinska Institute, Huddinge University Hospital, Sweden.
Hepatology. 1995 Nov;22(5):1404-8. doi: 10.1002/hep.1840220511.
Primary sclerosing cholangitis (PSC) is a biliary destructive disease mostly affecting patients with ulcerative colitis (UC). PSC has been suggested to be an independent risk factor for the development of colorectal malignancy in UC. Patients with PSC also have an increased risk of developing cholangiocarcinoma. This study aimed at assessing the cumulative risk of colorectal neoplasia in PSC and UC, and also to determine risk factors for the development of cholangiocarcinoma. Fifty-eight PSC patients were included. Forty PSC patients having extensive UC were each matched to two control patients of the same age, with extensive colitis and a comparable duration of the colitis, but without PSC. All UC patients had been under colonoscopic surveillance with multiple biopsies. Among the 40 PSC patients with UC, 16 developed colonic dysplasia or carcinoma, versus 10 in the control group (P < .001). The absolute cumulative risk of developing colorectal dysplasia/carcinoma in the PSC/UC groups was 9%, 31%, and 50% after 10, 20, and 25 years of disease duration. In the group with UC only, the corresponding risk was 2%, 5%, and 10%, respectively (P < .001). Ten patients with PSC developed cholangiocarcinoma, all but one having UC. In the control group, no cholangiocarcinoma occurred. Patients with PSC and UC with colorectal neoplasia developed cholangiocarcinoma significantly more often compared with patients with UC and PSC without colonic dysplasia/carcinoma (P < .02). This study demonstrates not only that patients with PSC and UC have a significantly higher risk of developing colorectal neoplasia compared with patients having UC only, but also that patients with PSC and UC having colorectal neoplasia are more prone to develop cholangiocarcinoma.
原发性硬化性胆管炎（PSC）是一种主要影响溃疡性结肠炎（UC）患者的胆汁破坏性疾病。PSC被认为是UC患者发生结直肠癌的独立危险因素。PSC患者发生胆管癌的风险也增加。本研究旨在评估PSC和UC患者发生结直肠肿瘤的累积风险，并确定胆管癌发生的危险因素。纳入了58例PSC患者。40例患有广泛性UC的PSC患者分别与两名年龄相同、患有广泛性结肠炎且结肠炎病程相当但无PSC的对照患者配对。所有UC患者均接受了结肠镜监测及多次活检。在40例合并UC的PSC患者中，16例发生了结肠发育异常或癌，而对照组为10例（P<0.001）。在PSC/UC组中，疾病持续10年、20年和25年后发生结直肠发育异常/癌的绝对累积风险分别为9%、31%和50%。仅在UC组中，相应风险分别为2%、5%和10%（P<0.001）。10例PSC患者发生了胆管癌，除1例患者外均患有UC。在对照组中，未发生胆管癌。与无结肠发育异常/癌的UC和PSC患者相比，合并结直肠肿瘤的PSC和UC患者发生胆管癌的频率明显更高（P<0.02）。本研究不仅表明，与仅患有UC的患者相比，PSC和UC患者发生结直肠肿瘤的风险显著更高，而且合并结直肠肿瘤的PSC和UC患者更易发生胆管癌。
