在以人口为基础的原发性硬化胆道炎炎炎性肠病队列中了解肝胰腺胆道癌风险
Kristel K Leung1,2,3, Wenbin Li4, Bettina Hansen1,2,5
1The Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, Ontario, Canada.
带有炎症性肠道疾病 (PSC-IBD) 的原发性硬化性胆道炎具有显著的癌症风险. 结肠切除术或胆囊切除术后的较高死亡率反映了潜在的疾病,而不是手术本身.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 在瘤学瘤学.
背景情况:
- 初级硬化性胆道炎 (PSC) 是一种前恶性疾病.
- 在患有炎症性肠病 (IBD) 的患者中,PSC会增加肝胆癌 (HPBCa) 和结直肠癌 (CRC) 的风险.
- 了解癌症负担和PSC-IBD的结果至关重要.
研究的目的:
- 描述当代PSC-IBD队列中的癌症负担.
- 为了评估随后的癌症,肝移植和死后结肠切除术或结肠切除术后的死亡率.
- 评估疾病的发展轨迹和相关风险.
主要方法:
- 在加拿大安大略省利用链接的卫生行政数据库 (2002-2018,后续到2021年).
- 计算HPBCa相关结果和非HPBCa相关移植/死亡的因果特定累积发病率.
- 采用多态马尔科夫模型来评估过渡概率和强度比.
主要成果:
- 在476名PSC-IBD患者中,54%的患者在10年后仍然没有发病.
- 大约20分之一的患者经历了与HPBCa相关的结果;高达4分之一的患者经历了与HPBCa无关的移植/死亡.
- 结肠切除术和结肠切除术后的死亡率较高,与潜在疾病严重程度有关.
结论:
- 在PSC-IBD患者面临的癌症,胆囊切除术,胆囊切除术和移植的显著风险.
- 术后死亡率的增加归因于严重的潜在疾病,而不是手术.
- 在PSC-IBD疾病轨迹的变化需要个性化管理和咨询.
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