Rozen P, Baratz M, Fefer F, Gilat T
Department of Gastroenterology, Tel Aviv Medical Center, Israel.
Gastroenterology. 1995 May;108(5):1361-70. doi: 10.1016/0016-5085(95)90683-5.
BACKGROUND/AIMS: Colorectal cancer associated with ulcerative colitis may be preceded by dysplastic changes potentially detectable by repeated endoscopic examinations. The aim of this study was to evaluate the incidence, course, and risk factors for dysplasia in a prospective endoscopic study.
One hundred fifty-four patients with ulcerative colitis for 7 or more years' duration were followed from 1976 to 1994 in an endoscopic surveillance program.
Five patients had 10 adenomatous polyps managed by polypectomy. Indefinite dysplasia was found in 16 patients, and none showed progressive dysplasia on follow-up. Low-grade dysplasia was detected in 10 patients; 2 had and 2 progressed to high-grade dysplasia. High-grade dysplasia was found in 7 patients; 4 were concurrent with or just preceded cancer. All 4 cases of cancer were first detected by surveillance, and 3 were successfully treated. Significant risk factors for dysplasia (all grades) and cancer included the extent of disease (P < 0.01), older age at onset of colitis (P = 0.01), and the duration of disease (P < 0.05). The adjusted risk for cancer was significantly increased (P = 0.04).
Indefinite dysplasia did not predict developing cancer. Low- or high-grade dysplasia was not frequent (8.5%) but was associated with progression to cancer. These can be detected and successfully treated by systematic endoscopic surveillance of patients with chronic (> or = 7 years), extensive (more than the rectosigmoid colon) ulcerative colitis.
背景/目的：溃疡性结肠炎相关的结直肠癌可能在发育异常改变之前出现，而反复的内镜检查有可能检测到这些改变。本研究的目的是在一项前瞻性内镜研究中评估发育异常的发生率、病程及危险因素。
1976年至1994年，对154例病程达7年或更长时间的溃疡性结肠炎患者进行内镜监测。
5例患者有10个腺瘤性息肉，通过息肉切除术处理。16例患者发现不确定的发育异常，随访中均未出现进展性发育异常。10例患者检测到低级别发育异常；2例发生高级别发育异常，2例进展为高级别发育异常。7例患者发现高级别发育异常；4例与癌症同时存在或在癌症之前出现。所有4例癌症均通过监测首次发现，并成功治疗了3例。发育异常（所有级别）和癌症的显著危险因素包括疾病范围（P < 0.01）、结肠炎发病时年龄较大（P = 0.01）以及病程（P < 0.05）。癌症的校正风险显著增加（P = 0.04）。
不确定的发育异常不能预测癌症发生。低级别或高级别发育异常并不常见（8.5%），但与癌症进展相关。通过对慢性（≥7年）、广泛性（超过直肠乙状结肠）溃疡性结肠炎患者进行系统的内镜监测，可以检测到这些情况并成功治疗。
