Marchesa P, Lashner B A, Lavery I C, Milsom J, Hull T L, Strong S A, Church J M, Navarro G, Fazio V W
Center for Inflammatory Bowel Disease, Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Gastroenterol. 1997 Aug;92(8):1285-8.
Ulcerative colitis (UC) patients with primary sclerosing cholangitis (PSC) may have an increased risk for colonic dysplasia or cancer. They also may have higher levels of carcinogenic secondary bile acids and, thus, be more likely to develop cancer in the right side of the colon, where secondary bile acid concentrations are highest.
Since 1983, 1212 UC patients have undergone total proctocolectomy with ileal pouch-anal anastomosis at the Cleveland Clinic. All 27 patients with PSC were compared with the remaining 1185 patients in a historical cohort study.
Dysplasia detected during cancer surveillance was the indication for surgery in 16 (59.5%) PSC patients and 136 (11.5%) controls [adjusted relative risk (RR), 6.9; 95% confidence interval (CI), 3.0-16.0]. Dysplasia or cancer was found in the resected specimen in 18 (66.7%) PSC patients and 145 (12.2%) controls (RR 10.4, CI 4.1-26.1). Right-sided cancers (proximal to the splenic flexure) were found in all four PSC patients with cancer and in 20 of 49 controls with cancer (RR 2.5, CI 1.3-5.4).
UC patients with PSC are at a significantly increased risk for dysplasia or cancer. The high proportion of right-sided cancers supports the contention that secondary bile acids are carcinogenic and increase the likelihood of cancer in the proximal colon.
患有原发性硬化性胆管炎（PSC）的溃疡性结肠炎（UC）患者发生结肠发育异常或癌症的风险可能会增加。他们体内致癌性次级胆汁酸水平也可能更高，因此更有可能在结肠右侧发生癌症，因为该部位次级胆汁酸浓度最高。
自1983年以来，1212例UC患者在克利夫兰诊所接受了全直肠结肠切除术并回肠贮袋肛管吻合术。在一项历史性队列研究中，将所有27例PSC患者与其余1185例患者进行了比较。
在癌症监测期间检测到的发育异常是16例（59.5%）PSC患者和136例（11.5%）对照患者手术的指征[调整相对风险（RR）为6.9；95%置信区间（CI）为3.0 - 16.0]。在切除标本中发现发育异常或癌症的PSC患者有18例（66.7%），对照患者有145例（12.2%）（RR 10.4，CI 4.1 - 26.1）。在所有4例患癌的PSC患者以及49例患癌对照患者中的20例中发现了右侧结肠癌（脾曲近端）（RR 2.5，CI 1.3 - 5.4）。
患有PSC的UC患者发生发育异常或癌症的风险显著增加。右侧结肠癌的高比例支持了次级胆汁酸具有致癌性并增加近端结肠癌发生可能性的观点。
