Rectal Cancer Risk and Survival after Total Colectomy for IBD:A Population-Based Study
| Autor: | Søren Laurberg, Anders Mark-Christensen, Katalin Veres, Rune Erichsen, Henrik Toft Sørensen |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Colorectal cancer Epidemiology Denmark Inflammatory bowel disease Total colectomy 0302 clinical medicine Crohn Disease Rectal cancer Child Colectomy Aged 80 and over education.field_of_study Surveillance medicine.diagnostic_test Incidence (epidemiology) Mortality rate Incidence Gastroenterology General Medicine Middle Aged Prognosis Ulcerative colitis 030220 oncology & carcinogenesis Child Preschool 030211 gastroenterology & hepatology Female Cohort study Adult Risk medicine.medical_specialty Adolescent Population Cancer stage 03 medical and health sciences Young Adult medicine Humans education Aged Neoplasm Staging Proportional Hazards Models Gynecology business.industry Rectal Neoplasms Infant Newborn Cancer Infant medicine.disease Proctoscopy Colitis Ulcerative business |
| Zdroj: | Christensen, A M, Erichsen, R, Veres, K, Laurberg, S & Sørensen, H T 2021, ' Rectal Cancer Risk and Survival after Total Colectomy for IBD : A Population-Based Study ', Diseases of the Colon and Rectum, vol. 64, no. 5, pp. 583-591 . https://doi.org/10.1097/DCR.0000000000001810 |
| Popis: | Background Patients undergoing total colectomy for IBD may develop cancer in the rectal remnant, but the association is poorly understood. Objectives This study aimed to examine the risk and prognosis of rectal cancer after total colectomy for IBD. Design This is a nationwide population-based study. Setting Treatment of the patients took place in Denmark from 1977 to 2013. Patients Patients with IBD undergoing total colectomy were included. Main outcome measures We examined the incidence of rectal cancer among patients with IBD and total colectomy and compared cancer stage to that of other patients with rectal cancer in Denmark. We used Kaplan-Meier methodology to estimate survival and Cox regression to estimate adjusted mortality rate ratios following a rectal cancer diagnosis, comparing patients with and without IBD and a rectal remnant. Results We identified 4703 patients with IBD (1026 Crohn's disease; 3677 ulcerative colitis) who underwent total colectomy with a rectal remnant. During 29,725 years of follow-up, 30 rectal cancers were observed, compared with 8 rectal cancers expected (standardized incidence ratio = 3.6 (95% CI, 2.4-5.1)). Cancer stage distributions were similar. Risk of rectal cancer 35 years after total colectomy was 1.9% (95% CI, 1.1%-2.9%). Five years after rectal cancer diagnosis, survival was 28% (95% CI, 12%-47%) and 38% (95% CI, 37%-38%) for patients with and without IBD and a rectal remnant. The adjusted mortality rate ratio 1 to 5 years after a rectal cancer diagnosis was 2.5 (95% CI, 1.6-3.9). Median time from last recorded nondiagnostic proctoscopy to rectal cancer diagnosis for patients with IBD and total colectomy was 1.1 years. Limitations This study was limited by the few outcomes and the use of administrative and not clinical data. Conclusion Long-term risk of rectal cancer following total colectomy for IBD was low. Survival following a diagnosis of rectal cancer was poorer for patients with IBD and total colectomy than for patients who had rectal cancer without IBD and total colectomy. Endoscopic surveillance, as it appeared to be practiced in this cohort, may be inadequate. See Video Abstract at http://links.lww.com/DCR/B497. RIESGO DE CANCER DE RECTO Y SUPERVIVENCIA DESPUES DE UNA COLECTOMIA TOTAL POR ENFERMEDAD INFLAMATORIA INTESTINAL: UN ESTUDIO POBLACIONAL: Los pacientes sometidos a colectomia total por enfermedad inflamatoria intestinal (EII) pueden desarrollar cancer en el remanente rectal, pero la asociacion es poco conocida.Examinar el riesgo y el pronostico del cancer de recto despues de una colectomia total para la EII.Estudio poblacional a nivel nacional.Dinamarca 1977-2013.Pacientes con EII sometidos a colectomia total.Examinamos la incidencia de cancer de recto entre pacientes con EII y colectomia total y comparamos el estadio del cancer con el de otros pacientes con cancer de recto en Dinamarca. Utilizamos la metodologia de Kaplan-Meier para estimar la supervivencia y la regresion de Cox para estimar las tasas de mortalidad ajustadas (aMRR) despues de un diagnostico de cancer de recto, comparando pacientes con y sin EII y un remanente rectal.Identificamos 4.703 pacientes con EII (1.026 enfermedad de Crohn; 3.677 colitis ulcerosa) que se sometieron a colectomia total con remanente rectal. Durante 29,725 anos de seguimiento, se observaron 30 canceres de recto, en comparacion con los 8 esperados [razon de incidencia estandarizada (SIR) = 3.6, (intervalo de confianza (IC) del 95%: 2.4-5.1)]. Las distribuciones de las etapas del cancer fueron similares. El riesgo de cancer de recto 35 anos despues de la colectomia total fue del 1,9% (IC del 95%: 1,1% -2,9%). Cinco anos despues del diagnostico de cancer de recto, la supervivencia fue del 28% (IC del 95%: 12% -47%) y del 38% (IC del 95%: 37% -38%) para los pacientes con y sin EII y un remanente rectal, respectivamente. La aMRR 1-5 anos despues de un diagnostico de cancer de recto fue de 2,5 (IC del 95%: 1,6-3,9). La mediana de tiempo desde la ultima proctoscopia no diagnostica registrada hasta el diagnostico de cancer de recto en pacientes con EII y colectomia total fue de 1,1 anos.Pocos resultados, uso de datos administrativos y no clinicos.El riesgo a largo plazo de cancer de recto despues de una colectomia total para la EII fue bajo. La supervivencia despues de un diagnostico de cancer de recto fue mas pobre para los pacientes con EII y colectomia total que para los pacientes con cancer de recto sin EII y colectomia total. La vigilancia endoscopica, como parecia practicarse en esta cohorte, puede ser inadecuada. Consulte Video Resumen en http://links.lww.com/DCR/B497. (Traduccion-Dr. Adrian Ortega). |
| Databáze: | OpenAIRE |
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