摘要
Background and Aim:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).Studies have shown tumorigenetic and histomorphological differences between IBD-associated CRC and non-IBD CRC,suggesting differences in tumor behavior and response to treatment.We aimed to compare tumor recurrence and survival rates following postoperative chemotherapy in CRC patients with and without IBD.Methods:Search of the Cleveland Clinic’s CRC database revealed 65 patients who had IBD-associated CRC and received postoperative adjuvant chemotherapy between 1994 and 2010.Twenty-one patients were excluded due to incomplete clinical data.Propensity score-matching based on age,surgery intent,CRC site,tumor grade,American Joint Committee on Cancer(AJCC)stage and T stage was used to match IBD and non-IBD patients(1:4).Competing risk and Cox regression models were used to analyze differences in disease-free survival and overall survival,respectively.Results:Forty-four patients with IBD-associated CRC were matched to 176 patients with non-IBD CRC.Among IBD patients,29(66%)had ulcerative colitis,14(32%)had Crohn’s disease,and one(2%)had indeterminate colitis.Mean IBD diagnosis age was 28.1±14.5 years,and mean IBD duration at time of CRC treatment was 21.5±12.6 years.Ten(23%)IBD patients had tumor recurrence compared with 34(19%)non-IBD patients(P=.074).There was no significant difference in disease-free survival(hazard ratio[HR]=0.60;95%CI:0.35–1.05;P=0.074)or overall survival(HR=0.87;95%CI:0.54–1.4;P=0.58)between IBD and non-IBD patients.Conclusion:Patients with IBD-associated CRC have comparable rates of tumor recurrence and survival following postoperative chemotherapy as CRC patients without IBD.Prospective studies are needed to confirm these findings and guide therapeutic decisions.
背景与目的:炎性肠病(IBD)患者具有一定结直肠癌发生风险。研究显示,IBD相关结直肠癌与非IBD相关结直肠癌在肿瘤发生机制和组织形态学上存在差异,提示其肿瘤行为和治疗反应也可能有所不同。我们旨在比较接受术后化疗IBD相关与非IBD相关的结直肠癌患者肿瘤复发及生存率的差异。方法:检索Cleve?land临床中心结直肠癌数据库,筛选出1994-2010年间的65例IBD相关结直肠癌且接受了术后辅助化疗的患者,排除21例临床资料不完整者。按照年龄、手术目的、肿瘤部位、肿瘤病理分级、AJCC分期和T分期,对IBD相关和非IBD相关的结直肠癌患者进行1:4的病例匹配分组。分别采用竞争风险模型和Cox回归模型来评估IBD对无病生存和总体生存的影响。结果:44例IBD相关和176例非IBD相关的结直肠癌患者完成匹配。在IBD组患者中,29例(66%)为溃疡性结肠炎,14例(19%)为克罗恩病,1例(2%)诊断为不确定型肠炎。IBD平均诊断年龄为(28.1±14.5)岁,IBD诊断至结直肠癌治疗的平均间期为(21.5±12.6)年。10例(23%)IBD组患者出现了肿瘤复发,而非IBD组则有34例(19%)复发(P=0.074)。IBD组与非IBD组患者无瘤生存率(HR=0.60;95%CI:0.35~1.05;P=0.074)和总体生存率(HR=0.87;95%CI:0.54~1.4;P=0.58)的差异均无统计学意义。结论:接受术后化疗的IBD相关结直肠癌患者,其复发率与生存率与非IBD相关结直肠癌患者相当。有必要行进一步的前瞻性研究来证实这些发现,以指导治疗决策。
