摘要
背景与目的:炎症性肠病(IBD)患者结直肠癌的发生风险升高。本研究旨在分析美国IBD相关结直肠癌手术切除率的变化趋势。方法:我们收集了美国住院样本数据库1995-2012年间的相关病例资料。采用多因素Joinpoint回归模型分析年龄标化的IBD相关结直肠癌的手术切除率的时间变化趋势。主要结局指标是IBD相关结直肠癌的手术切除率。结果:共纳入1995-2012年间3,597,168例IBD出院病例,其中275,479例接受了结直肠癌切除手术。IBD人群中的结直肠癌切除率从1995年至2012年显著下降,各个年龄组的年切除例数均显著下降,18-39岁组、40-49岁组、50-74岁组和75岁以上组每100,000例IBD患者中结直肠癌年切除例数从1995年至2012年分别减少393、359、293和159例(均P<0.001);其中,近端结直肠癌年切除例数分别减少149、130、95和50例(均P<0.001),远端结直肠癌年切除例数分别减少104、123、123和82例(均P<0.001)。多因素Poisson回归分析显示,校正年龄和性别因素后,结直肠癌切除率从1995-2012年间年均下降了3.9%。结论:从1995-2012年间,IBD患者中的结直肠癌切除率逐年下降,且近端和远端结直肠癌切除率均呈现下降趋势。这一人群水平的下降趋势反应了美国IBD相关结直肠癌发病率的下降。
Background and objective:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).This study aimed to analyse the trends in rates of resection for IBD-related CRC in the USA.Methods:We used the Nationwide Inpatient Sample from 1995 to 2012.Temporal trends in age-adjusted rates of resection for CRC in the setting of IBD were analysed using multivariate Joinpoint regression models.The primary outcome was surgical resection of CRC in the setting of IBD.Results:We included 3597168 IBD discharges in the present study,of which 275479 underwent CRC resection between 1995 and 2012.The annual CRC resection rates among IBD population decreased significantly from 1995 to 2012.This decrease was significant in all age groups with an annual decrease of 393(P<0.001),359(P<0.001),293(P<0.001)and 159(P<0.001)per 100000 IBD discharges between 1995 and 2012 for age groups 18–39,40–49,50–74 and>75 years,respectively.The annual IBD-CRC resection rate per 100000 IBD discharges for proximal CRC decreased by 149(P<0.001),130(P<0.001),95(P<0.001)and 50(P<0.001),respectively,and the annual distal CRC resections per 100000 IBD discharges decreased by 104(P<0.001),123(P<0.001),123(P<0.001)and 82(P<0.001),respectively,for age groups 18–39,40–49,50–74 and>75 years,between 1995 and 2012.On multivariate Poisson regression analysis,after adjustment for age and sex,CRC resections decreased by 3.9%each year from 1995 to 2012.Conclusions:CRC resection rates among IBD patients have continued to decrease annually from 1995 to 2012.There is a population-level decrease in resection of both proximal and distal CRC reflecting a decreasing incidence of IBD-related CRC incidence in the USA.
