Bansal P, Sonnenberg A
Department of Veterans Affairs, Medical College of Wisconsin, Milwaukee, USA.
Am J Gastroenterol. 1996 Jan;91(1):44-8.
It is unknown whether colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) behaves differently from regular CRC in patients without IBD. A case-control study was conducted to compare CRC in patients with and without underlying IBD.
The Department of Veterans Affairs (VA) maintains a computerized file of all hospital discharges among U.S. military veterans since 1970. This file accrues the data of 1 million hospital discharges per year. All patients with IBD and all patients with CRC who had been discharged from a VA hospital between 1981 and 1993 were selected. The influence of various risk factors on the occurrence of CRC in IBD and its mortality in patients with and without IBD was tested by logistical regression analyses.
Of the 11,446 subjects with IBD, 371 had colon cancer. CRC was diagnosed in 52,243 subjects without IBD. CRC patients with IBD were 7 yr younger than those without IBD, but in patients with Crohn's disease, more cancers were located in the proximal colon (chi 2 = 18.10, df = 5, p = 0.003). The occurrence of CRC in IBD was influenced by the following risk factors: age [odds ratio (OR) = 1.45, 95% confidence interval (CI) = 1.35-1.57], sclerosing cholangitis (OR) = 3.41, CI = 2.03-5.73), and history of a disease associated with consumption of nonsteroidal anti-inflammatory drugs (NSAID) (OR = 0.84, CI = 0.65-1.09). Sex, race, and type of IBD did not exert a significant influence on the development of cancer. Cancer-related mortality was influenced by the following risk factors: age (OR = 1.16, CI = 1.14-1.18), male gender (OR = 1.23, CI = 1.06-1.44), white race (OR) = 0.97, CI = 0.96-0.99), and history of NSAID consumption (OR = 0.68, CI = 0.65-0.72). Presence of IBD was not associated with a significant influence on CRC mortality (OR = 1.00, CI = 0.70-1.43).
CRC affects IBD patients at a younger age and is characterized by a more proximal localization when compared with CRC of non-IBD patients. NSAID exert a protective influence against CRC in patients with IBD similarly as in patients without IBD. Sclerosing cholangitis is associated with a strong risk of developing colon cancer in patients with IBD.
炎症性肠病（IBD）患者的结直肠癌（CRC）与无IBD患者的普通CRC表现是否不同尚不清楚。进行了一项病例对照研究，以比较有和无潜在IBD患者的CRC情况。
自1970年以来，美国退伍军人事务部（VA）维护着一份美国退伍军人所有医院出院情况的计算机化档案。该档案每年积累100万份医院出院数据。选取了1981年至1993年间从VA医院出院的所有IBD患者和所有CRC患者。通过逻辑回归分析测试了各种风险因素对IBD患者CRC发生情况及其在有和无IBD患者中的死亡率的影响。
在11446例IBD患者中，371例患有结肠癌。在52243例无IBD的受试者中诊断出CRC。患有IBD的CRC患者比无IBD的患者年轻7岁，但在克罗恩病患者中，更多癌症位于近端结肠（χ² = 18.10，自由度 = 5，p = 0.003）。IBD患者中CRC的发生受以下风险因素影响：年龄[比值比（OR）= 1.45，95%置信区间（CI）= 1.35 - 1.57]、硬化性胆管炎（OR = 3.41，CI = 2.03 - 5.73）以及与非甾体抗炎药（NSAID）使用相关疾病的病史（OR = 0.84，CI = 0.65 - 1.09）。性别、种族和IBD类型对癌症发生没有显著影响。癌症相关死亡率受以下风险因素影响：年龄（OR = 1.16，CI = 1.14 - 1.18）、男性（OR = 1.23，CI = 1.06 - 1.44）、白人种族（OR = 0.97, CI = 0.96 - 0.99）以及NSAID使用病史（OR = 0.68，CI = 0.65 - 0.72）。IBD的存在对CRC死亡率没有显著影响（OR = 1.00，CI = 0.70 - 1.43）。
与非IBD患者的CRC相比，CRC在更年轻的IBD患者中出现，且其特征是定位更靠近近端。NSAID对IBD患者的CRC同样具有保护作用，如同对无IBD患者一样。硬化性胆管炎与IBD患者患结肠癌的高风险相关。
