摘要
Background and aim:Crohn’s colitis(CC)is associated with primary sclerosing cholangitis(PSC).However the risk of colon cancer or dysplasia in CC and PSC is unclear.Our aim was to study the risk of colon neoplasia in CC in patients with and without PSC.Methods:This is a nested,case-control cohort study of all patients diagnosed with concurrent CC and PSC,seen at the Cleveland Clinic between 1985 and 2012.Forty-three patients with both CC and PSC were compared with a random sample of 159 CC controls without PSC during the same period.Results:Seven(16.3%)of 43 CC patients with PSC developed colon cancer or dysplasia,compared with 22(13.8%)of 159 controls(P=0.98).Of seven colon neoplasia cases in the PSC group,100%occurred proximal to the splenic flexure,compared with 50%(11/22)cases of colon neoplasia in controls occurring in the proximal colon(P=0.001).Based on Cox regression analysis,male gender independently increased the risk of neoplasia[hazard ratio(HR)=2.68;95%confidence interval(CI)1.30-5.54;P=0.008],as did age at CC diagnosis(HR=1.29;95%CI 1.14-1.47;P<0.001),while the use of azathioprine/6-mercaptopurine was protective(HR=0.30;95%CI 0.13-0.70;P=0.005).The presence of PSC did not increase the risk for colon neoplasia(HR=0.45;95%CI 0.18-1.13;P=0.09).Conclusions:CC patients with PSC appear not to be at increased risk of developing colon neoplasia.Among patients in our cohort with colon neoplasia and concurrent PSC,the neoplasia occurred in the proximal colon in all cases.
背景与目的:克罗恩病结肠炎(CC)常伴发原发性硬化性肝管炎(PSC)。然而,在CC/PSC患者中结肠癌或瘤变的风险仍不清楚。本研究目的是研究伴或不伴PSC的CC患者结肠瘤变的风险。方法:本研究系巢式病例对照研究,研究对象是1985-2012年间Cleveland Clinic收治的CC合并PSC患者。比较43例CC合并PSC患者(PSC组)与同期159例CC未合并PSC患者(对照组)的结肠瘤变率。结果:43例PCS组患者中有7例(16.3%)出现结肠癌或瘤变,而159例对照组中有22例(13.8%)出现结肠癌或瘤变(P=0.98)。PSC组出现结肠瘤变的7例患者瘤变均发生在近端结肠(脾曲近端),而对照组仅50%(11/22)的瘤变发生在近端结肠(P=0.001)。Cox回归分析显示,男性患者(HR=2.68;95%CI:1.30-5.54;P=0.008)和CC诊断年龄(HR=1.29;95%CI:1.14-1.47;P<0.001)是发生结肠瘤变的独立危险因素,而硫唑嘌呤/6巯基嘌呤的使用则具有保护作用(HR=0.30;95%CI:0.13-0.70;P=0.005)。合并PSC并不会增加结肠腺瘤的发生风险(HR=0.45;95%CI:0.18-1.13;P=0.09)。结论:合并PSC并不会增加CC患者结肠瘤变的风险。在我们这组CC/PSC病例中,结肠瘤变均发生在近端结肠。
基金
The study is supported by a research grant from the inflammatory bowel disease working group(U.N.)。
作者简介
Corresponding author:Udayakumar Navaneethan.Digestive Disease Institute-Desk A31,The Cleveland Clinic Foundation,9500 Euclid Avenue,Cleveland,OH 44195,USA.Tel:t1-216-502-0981,Fax:t1-216-444-6305,Email:udhaykumar81@gmail.com。
