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Cáncer colorrectal en la colitis ulcerosa: un estudio de cohorte basado en la población escandinava
Ola Olén1, Rune Erichsen2, Michael C Sachs3
1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden.
Lancet (London, England)
|January 14, 2020
Resumen
Los pacientes con colitis ulcerosa (UC) se enfrentan a un mayor riesgo de cáncer colorrectal (CRC) y muerte por CRC. Si bien los diagnósticos están menos avanzados y los riesgos están disminuyendo, aún se necesitan pautas de vigilancia mejoradas para los pacientes con UC.
Área de la Ciencia:
- Gastroenterología
- En el campo de la oncología
- Epidemiología
Sus antecedentes:
- La colitis ulcerosa (UC) es un factor de riesgo conocido para el cáncer colorrectal (CRC).
- Los estudios anteriores a menudo usaban datos obsoletos de tratamiento / vigilancia y no tenían en cuenta completamente sesgos como el tiempo de espera y el sesgo de vigilancia.
- Es necesario evaluar el riesgo de CCR en pacientes con UC teniendo en cuenta el estadio tumoral y la mortalidad ajustada por estadio.
Objetivo del estudio:
- Comparar los riesgos generales y específicos de cada país de incidencia y mortalidad del cáncer colorrectal (CRC) en pacientes con colitis ulcerosa (UC).
- Evaluar el riesgo de CCR en pacientes con UC teniendo en cuenta el estadio tumoral y los posibles sesgos.
Principales métodos:
- Estudio de cohorte basado en la población en Dinamarca y Suecia (1969-2017) que incluyó a 96.447 pacientes con UC y 949.207 controles emparejados.
- Se utilizaron los registros nacionales para la selección de pacientes y la regresión de Cox para calcular los ratios de riesgo (HR) de la incidencia y la mortalidad por CCR.
- Análisis ajustados para el estadio del tumor en el momento del diagnóstico.
Principales resultados:
- Los pacientes con UC presentaron un aumento de 1,66 veces el riesgo de incidencia de CRC y un aumento de 1,59 veces el riesgo de mortalidad por CRC en comparación con los controles.
- Los pacientes con UC fueron diagnosticados con CCR menos avanzado (p< 0, 0001).
- El análisis ajustado por etapas confirmó un aumento del riesgo de muerte por CCR (HR 1.54) en pacientes con UC, con riesgos excesivos que disminuyen con el tiempo.
Conclusiones:
- Las personas con UC tienen un riesgo significativamente mayor de desarrollar CCR y morir por ella, a pesar de los diagnósticos en etapa temprana.
- El exceso de riesgos de incidencia y mortalidad de CCR en pacientes con UC ha disminuido a lo largo de los períodos calendarios.
- Las directrices internacionales de vigilancia para los pacientes con UC requieren una mejora adicional para mitigar los riesgos de CCR.
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