SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Stéphane NAHON
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2017/05  
 
  2017 May;15(5):665-674.e5  
  doi: 10.1016/j.cgh.2016.11.025  
 
  Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis.  
 
  Fumery M, Dulai PS, Gupta S, Prokop LJ, Ramamoorthy S, Sandborn WJ, Singh S  
  https://www.ncbi.nlm.nih.gov/pubmed/27916678  
 
 

Abstract

BACKGROUND & AIMS:

Little is known about outcomes of patients with ulcerative colitis with low-grade dysplasia (UC-LGD). We estimated the incidence of and risk factors for progression to colorectal cancer (CRC) in cohorts of patients with UC-LGD who underwent surveillance (surveillance cohort), and the prevalence of dysplasia-related findings among patients who underwent colectomy for UC-LGD (surgical cohort).

METHODS:

We performed a systematic literature review through June 1, 2016, to identify cohort studies of adults with UC-LGD. We estimated pooled incidence rates of CRC and risk factors associated with dysplasia progression in surveillance cohorts, and prevalence of synchronous advanced neoplasia (CRC and/or high-grade dysplasia) in surgical cohorts.

RESULTS:

In 14 surveillance cohort studies of 671 patients with UC-LGD (52 developed CRC), the pooled annual incidence of CRC was 0.8% (95% confidence interval [CI], 0.4-1.3); the pooled annual incidence of advanced neoplasia was 1.8% (95% CI, 0.9-2.7). Risk of CRC was higher when LGD was diagnosed by expert gastrointestinal pathologist (1.5%) than by community pathologists (0.2%). Factors significantly associated with dysplasia progression were concomitant primary sclerosing cholangitis (odds ratio [OR], 3.4; 95% CI, 1.5-7.8), invisible dysplasia (vs visible dysplasia; OR, 1.9; 95% CI, 1.0-3.4), distal location (vs proximal location; OR, 2.0; 95% CI, 1.1-3.7), and multifocal dysplasia (vs unifocal dysplasia; OR, 3.5; 95% CI, 1.5-8.5). In 12 surgical cohort studies of 450 patients who underwent colectomy for UC-LGD, 34 patients had synchronous CRC (pooled prevalence, 17%; 95% CI, 8-33).

CONCLUSION:

In a systematic review of the literature, we found that among patients with UC-LGD under surveillance, the annual incidence of progression to CRC was 0.8%; differences in rates of LGD diagnosis varied with pathologists' level of expertise. Concomitant primary sclerosing cholangitis, invisible dysplasia, distal location, and multifocal LGD are high-risk features associated with dysplasia progression.

  
Question posée
 
Quels sont l’incidence, les facteurs de risque et le devenir du cancer colorectal chez les patients ayant une dysplasie de bas grade au cours de la RCH : méta-analyse?
 
Question posée
 
Risque annuel de progression vers un CCR: 0,8%. Facteurs de risque habituels : Cholangite sclérosante, localisation distale, dysplasie non visible macroscopiquement.
 
Commentaires

Cette méta-analyse confirme les facteurs habituels de CCR au cours de la RCH avec malgré tout une progression vers le CCR plutôt faible. L’évolution vers un cancer était plus élevée quand le pathologiste était expert soulignant la difficulté de porter le diagnostic de dysplasie de bas grade au cours de la RCH.
 
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