BACKGROUND Inflammatory bowel disease(IBD)patients with post-inflammatory polyps(PIPs)may carry an increased risk of colorectal neoplasia(CRN)including dysplasia and cancer.Current guidelines recommend active colonosc...BACKGROUND Inflammatory bowel disease(IBD)patients with post-inflammatory polyps(PIPs)may carry an increased risk of colorectal neoplasia(CRN)including dysplasia and cancer.Current guidelines recommend active colonoscopy follow-up for these patients.However,the evidence for guidelines is still poor.In addition,some recent high-quality reports present a different view,which challenges the current guidelines.We hypothesize that IBD patients with PIPs are at increased risk of CRN.AIM To evaluate the risk of CRN in IBD patients with and without PIPs.METHODS A systematic search of PubMed,Embase,Cochrane Library,and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs.In addition,we screened the reference lists and citation indices of the included studies.Quality assessment was performed using the Newcastle–Ottawa Scale.Pooled odds ratio(OR)was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN.Sensitivity analysis,subgroup analysis,and assessment of publication bias were performed to examine the sources of heterogeneity.RESULTS Twelve studies with 5819 IBD patients,including 1281(22.01%)with PIPs,were considered eligible for this meta-analysis.We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs[OR 2.01;95%confidence interval(CI):1.43–2.83].The results were similar when colorectal cancer was used as the study endpoint(OR 2.57;95%CI:1.69–3.91).Furthermore,the risk of CRN was still increased(OR 1.80;95%CI:1.12–2.91)when restricted to ulcerative colitis patients.Heterogeneity was high among the included studies(I^(2)=75%).Subgroup analysis revealed that the high heterogeneity was due to the study design.Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies.No significant publication bias was found in the funnel plots.CONCLUSION IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs,which support the current guidelines.However,a high-quality randomized controlled trial is warranted.展开更多
Background Prognosis varies among stageⅣcolorectal cancer(CRC).Our study aimed to build a robust prognostic nomogram for predicting overall survival(OS)of patients with stageⅣCRC in order to provide evidence for ind...Background Prognosis varies among stageⅣcolorectal cancer(CRC).Our study aimed to build a robust prognostic nomogram for predicting overall survival(OS)of patients with stageⅣCRC in order to provide evidence for individualized treatment.Method We collected the information of 16,283 patients with stageⅣCRC in the Surveillance,Epidemiology,and End Results(SEER)database and then randomized these patients in a ratio of 7:3 into a training cohort and an internal validation cohort.In addition,501 patients in the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)database were selected and used as an external validation cohort.Univariate and multivariate Cox analyses were used to screen out significant variables for nomogram establishment.The nomogram model was assessed using time-dependent receiveroperating characteristic curve(time-dependent ROC),concordance index(C-index),calibration curve,and decision curve analysis.Survival curves were plotted using the Kaplan–Meier method.Result The C-index of the nomogram for OS in the training,internal validation,and external validation cohorts were 0.737,0.727,and 0.655,respectively.ROC analysis and calibration curves pronounced robust discriminative ability of the model.Further,we divided the patients into a high-risk group and a low-risk group according to the nomogram.Corresponding Kaplan–Meier curves showed that the prediction of the nomogramwas consistent with the actual practice.Additionally,model comparisons and decision curve analysis proved that the nomogram for predicting prognosis was significantly superior to the tumor-node-metastasis(TNM)staging system.Conclusions We constructed a nomogram to predict OS of the stageⅣCRC and externally validate its generalization,which was superior to the TNM staging system.展开更多
基金The National Key R&D Program of China,No.2017YFC1308800National Natural Science Foundation of China,No.81970482+3 种基金Natural Science Foundation of Guangdong Province,China,No.2019A1515011313Sun Yat-Sen University 5010 Project,No.2010012the Fundamental Research Funds for the Central Universities,No.19ykpy05National Key Clinical Discipline.
文摘BACKGROUND Inflammatory bowel disease(IBD)patients with post-inflammatory polyps(PIPs)may carry an increased risk of colorectal neoplasia(CRN)including dysplasia and cancer.Current guidelines recommend active colonoscopy follow-up for these patients.However,the evidence for guidelines is still poor.In addition,some recent high-quality reports present a different view,which challenges the current guidelines.We hypothesize that IBD patients with PIPs are at increased risk of CRN.AIM To evaluate the risk of CRN in IBD patients with and without PIPs.METHODS A systematic search of PubMed,Embase,Cochrane Library,and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs.In addition,we screened the reference lists and citation indices of the included studies.Quality assessment was performed using the Newcastle–Ottawa Scale.Pooled odds ratio(OR)was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN.Sensitivity analysis,subgroup analysis,and assessment of publication bias were performed to examine the sources of heterogeneity.RESULTS Twelve studies with 5819 IBD patients,including 1281(22.01%)with PIPs,were considered eligible for this meta-analysis.We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs[OR 2.01;95%confidence interval(CI):1.43–2.83].The results were similar when colorectal cancer was used as the study endpoint(OR 2.57;95%CI:1.69–3.91).Furthermore,the risk of CRN was still increased(OR 1.80;95%CI:1.12–2.91)when restricted to ulcerative colitis patients.Heterogeneity was high among the included studies(I^(2)=75%).Subgroup analysis revealed that the high heterogeneity was due to the study design.Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies.No significant publication bias was found in the funnel plots.CONCLUSION IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs,which support the current guidelines.However,a high-quality randomized controlled trial is warranted.
基金supported by the National Natural Science Foundation of China[no.81970482,X.S.H.]National Natural Science Foundation of China[no.82172561,X.S.H.]Guangdong Basic and Applied Basic Research Foundation[no.2019A1515011313,X.S.H.].
文摘Background Prognosis varies among stageⅣcolorectal cancer(CRC).Our study aimed to build a robust prognostic nomogram for predicting overall survival(OS)of patients with stageⅣCRC in order to provide evidence for individualized treatment.Method We collected the information of 16,283 patients with stageⅣCRC in the Surveillance,Epidemiology,and End Results(SEER)database and then randomized these patients in a ratio of 7:3 into a training cohort and an internal validation cohort.In addition,501 patients in the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)database were selected and used as an external validation cohort.Univariate and multivariate Cox analyses were used to screen out significant variables for nomogram establishment.The nomogram model was assessed using time-dependent receiveroperating characteristic curve(time-dependent ROC),concordance index(C-index),calibration curve,and decision curve analysis.Survival curves were plotted using the Kaplan–Meier method.Result The C-index of the nomogram for OS in the training,internal validation,and external validation cohorts were 0.737,0.727,and 0.655,respectively.ROC analysis and calibration curves pronounced robust discriminative ability of the model.Further,we divided the patients into a high-risk group and a low-risk group according to the nomogram.Corresponding Kaplan–Meier curves showed that the prediction of the nomogramwas consistent with the actual practice.Additionally,model comparisons and decision curve analysis proved that the nomogram for predicting prognosis was significantly superior to the tumor-node-metastasis(TNM)staging system.Conclusions We constructed a nomogram to predict OS of the stageⅣCRC and externally validate its generalization,which was superior to the TNM staging system.
