哪些因素可能影响IBD患者的结直肠癌风险
创作:aluba 审核:aluba 01月05日
  • 纳入164项研究(涉及31种潜在预后因素)进行荟萃分析,总结IBD患者的aCRN的相关预后因素;
  • 鉴定出13种风险因素,包括:广泛性病变、溃疡性结肠炎(相对于克罗恩病)、低度增生、任意类型的增生、狭窄、原发性硬化性胆管炎、炎症性息肉、结直肠癌家族史、结肠部分切除、非整倍性、男性、年龄、组织学炎症;
  • 另外鉴定出5种保护性因素,包括:结肠镜检查、5-氨基水杨酸、巯嘌呤类药物、吸烟、他汀类药物。
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aluba
IBD患者的结直肠癌风险增加。来自Gastroenterology上发表的一项荟萃分析,总结了164项研究,鉴定出IBD患者的进展期结直肠肿瘤(advanced colorectal neoplasia,aCRN,包括高度增生或结直肠癌)的13种风险因素,及5种保护性因素。
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Gastroenterology [IF:17.373]

Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis

IBD患者的进展期结直肠肿瘤的预后因素

10.1053/j.gastro.2020.12.036

2020-12-28, Review

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Background and aims: Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). We performed a systematic review and meta-analysis to identify all prognostic factors for advanced colorectal neoplasia (aCRN, high-grade dysplasia or CRC) in patients with IBD.
Methods: A systematic literature search was conducted according to the MOOSE guidelines. Risk of bias was assessed using the Quality in Prognostic Studies tool. Random-effects models were created separately for odds and hazard ratios, different study designs, and univariable or multivariable data. The evidence for all prognostic factors was categorized as ‘weak’, ‘moderate’, or ‘strong’, based on estimate of effect sizes, heterogeneity, and risk of bias.
Results: A total of 164 studies were included allowing pooled analysis of 31 potential prognostic factors. In the univariable analysis, the evidence for extensive disease was classified as strong while evidence for low-grade dysplasia, strictures, primary sclerosing cholangitis, post-inflammatory polyps, family history of CRC, and ulcerative colitis versus Crohn’s disease was considered moderate. Evidence for any dysplasia, colon segment resection, aneuploidy, male sex and age was classified as weak. In addition, histologic inflammation was identified as a risk factor in multivariable analysis (weak evidence). The evidence for the protective factors colonoscopic surveillance, 5-ASA, thiopurines, and smoking was moderate in univariable analysis. Multivariable analysis provided weak evidence for statin use.
Conclusion: In this systematic review and meta-analysis we identified 13 risk factors and 5 protective factors for aCRN in IBD patients, based on univariable and/or multivariable pooled analyses. These findings might lay the groundwork for an improved CRC risk stratification-based surveillance in IBD.

First Authors:
Anouk M Wijnands

Correspondence Authors:
Bas Oldenburg

All Authors:
Anouk M Wijnands,Michiel E de Jong,Maurice W M D Lutgens,Frank Hoentjen,Sjoerd G Elias,Bas Oldenburg,on behalf of the Dutch Initiative on Crohn and Colitis (ICC)

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