Colorectal cancer in Crohn's disease: closing the gap
Menée au Danemark et en Suède à partir de données de registres des cancers sur la période 1969-2017 portant sur 47 035 patients atteints de la maladie de Crohn et sur 463 187 témoins, cette étude analyse l'association entre cette maladie et le risque de développer un cancer colorectal (499 cas) ou le risque de décès associé (296 décès)
In the mid-20th century, astute clinicians and epidemiologists observed the association between ulcerative colitis and colorectal cancer (CRC). Initially, prophylactic colectomy after 10 years of disease was universally recommended. Nowadays, due to better understanding of CRC risk, improved medical therapy, and better endoscopic techniques, colonoscopy surveillance has fortunately replaced prophylactic colectomy in patients with ulcerative colitis. The association between Crohn's disease and CRC has been less clear. Early studies in the 1960s found no association between Crohn's disease and CRC, and conflicting studies followed for decades. Why are the results of studies evaluating Crohn's disease and CRC so heterogenous? Based on current models of colonic inflammation as the primary driver of CRC risk, isolated ileal or limited colonic involvement are not expected to substantially increase CRC risk; inclusion of these patients with Crohn's disease in analyses of CRC risk may have diluted risk estimates. Even when disease extent was accounted for in analyses, limitations of disease extent classification based solely on administrative codes must be considered, as they have been shown to be inaccurate in describing disease location in Crohn's disease.
The Lancet Gastroenterology & Hepatology , commentaire, 2019