潰瘍性大腸炎における結腸癌:スカンジナビアの集団ベースのコホート研究
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
まとめ
潰瘍性大腸炎 (UC) の患者は,大腸癌 (CRC) とCRCによる死亡のリスクが高くなります. 診断は進んでおらず リスクは減少しているが,UC患者に対する改善された監視ガイドラインは依然として必要である.
科学分野:
- 胃腸内科
- 腫瘍学
- 流行病学
背景:
- 潰瘍性大腸炎 (UC) は,大腸癌 (CRC) の既知の危険因子である.
- 以前の研究では,しばしば時代遅れの治療/監視データを使用し,リードタイムや監視バイアスなどのバイアスを完全に考慮していなかった.
- 腫瘍のステージとステージ調整された死亡率を考慮して,UC患者のCRCリスクを評価する必要がある.
研究 の 目的:
- 潰瘍性大腸炎 (UC) の患者における結腸癌 (CRC) 発生率と死亡率の総合的および国別リスクを比較する.
- 腫瘍のステージと潜在的なバイアスを考慮しながら,UC患者のCRCリスクを評価する.
主な方法:
- デンマークとスウェーデン (1969年−2017年) で行われた集団コホート研究で,96,447人のUC患者と949,207人の対照群を対象とした.
- CRCの発生率と死亡率のハザード比率 (HRs) を計算するために,患者選択とコックス回帰のための国家登録を使用した.
- 診断時に腫瘍の段階を調整した分析
主要な成果:
- UC患者では,対照群と比較して,CRCの発生率が1. 66倍,CRCの死亡率が1. 59倍増加しました.
- UC患者は,より進行していないCRCと診断された (p<0. 0001).
- ステージ調整した分析では,UC患者のCRC死亡リスクの増加 (HR1. 54) が確認され,過剰リスクは時間とともに減少した.
結論:
- UCを持つ人は,早期の診断にもかかわらず,CRCを発症し死亡するリスクが著しく高まります.
- UC患者におけるCRC発生率と死亡率の過剰リスクは,カレンダー期間中に減少した.
- UC患者の国際的監視ガイドラインは,CRCのリスクを軽減するためにさらに改善する必要があります.
関連する概念動画
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
795
Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
795
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
570
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
570
01:29Drugs for Treatment of Ulcerative Colitis in IBD
388
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
388
01:21Inflammatory Bowel Disease V: Surgical Management
395
Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Here are some common surgical interventions for IBD:
395
01:30Inflammatory Bowel Disease II: Crohn's Disease
862
Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
862
01:17Chronic Bowel Disorders: Introduction
701
Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
701