| Research backgroundUlcerative colitis,which mainly involves the colorectum,is an autoimmune disease with complex pathogenesis,multiple causes and multiple genes.Ulcerative colitis associated colorectal cancer(CAC or UC-CRC)is the most serious complication in patients with UC.The incidence of UC-CRC is 4-10 times higher than that of sporadic colorectal cancer.UC-CRC accounts for only 1-2%of all CRC cases in the general population,but its mortality can reach 10%-15%in all IBD patients[2].A newly published Globocan interpretation of global cancer statistics in 2020 shows that the incidence of colorectal cancer is 10%,ranking 3rd worldwide(3rd among men and 2nd among women),and the mortality rate is 2nd,9.4%worldwide(3rd among men and 3rd among women)[1].Numerous studies have shown that inflammation plays an increasingly prominent r ole in cancer,and the role of inflammation in UC-CRC should not be ignored.Inflammation-related risk factors,such as the duration of inflammation,the extent and severity of inflammation,are strongly associated with the risk of UC-CRC.From this,it can be inferred that the higher the level of histological inflammatory activity,the higher the risk of clinical recurrence,dysplasia,and colorectal resection.So,we need to quantify the burden of histological inflammation,in the process of treatment of UC patients,according to the histological inflammation index,endoscopic and histologic grading,in patients with UC to monitor UC development to provide better risk stratification for colorectal cancer,to develop test strategies and treatment,reduce the risk of development of UC-UC CRC.Research objectivesThe general data and clinical characteristics of patients with UC were analyzed,and histological inflammation score was performed for all patients with UC according to the pathological results.To observe the differences between the scores in the UC canceration group,the UC precancerous lesion group and the UC group,to evaluate the correlation between the histological inflammatory scores and general data and clinical characteristics,to evaluate the correlation between the highest HIA,average HIA and improved TR scores,and to evaluate the clinical usefulness of the histological inflammatory scores in UC.Research MethodsPatients with ulcerative colitis who were hospitalized in Qilu Hospital of Shandong University from January 2012 to December 2020 and underwent colorectal examination and histomathological examination were selected to collect and summarize the data.Risk factors for progression of UC to UC-CRC and precancerous lesions were analyzed.According to the histopathological report,all UC patients included in the study were divided into three groups:The histological inflammatory burden scores,including the highest HIA score,average HIA score,and modified TR score,were calculated respectively in the UC canceration group,UC precancerous lesion group,and UC group.The correlation between histological inflammatory burden and colorectal cancer and precancerous lesion,as well as the correlation between inflammatory histological inflammatory burden and clinical characteristics were analyzed.The results of the study1.General information:A total of 306 patients were included in the study,There are 168 males(54.9%)and 138 females(45.1%),with a male to female ratio of 1.22:1,among which 68 were in the youth group(22.2%),164 were in the middle age group(53.6%),and 74 were in the elderly group(26.2%).The number of patients with disease course ≤1 year was the largest(154).Among them,87 cases(28.4%)were less than course of disease ≤8 years(1-year),44 cases(14.4%)were less than course of disease≤15 years(8-year),16 cases(5.2%)were less than course of disease ≤20 years(15-year),and 5 cases(1.6%)were>20 years(20-year).According to BMI:39 cases(12.7%)were undernourished,139 cases(45.4%)were normal,69 cases(22.5%)were overweight,and 12 cases(3.9%)were obese.Among the 306 patients,61(19.9%)had smoking history,73(23.9%)had drinking history,40(13.1%)had hypertension,17(5.6%)had coronary heart disease,and 20(6.5%)had diabetes.2.Clinical manifestations:Among the main clinical manifestations,there were 29 cases(9.5%)of hematic stools,222 cases(72.5%)of mucous pus and blood stools,211 cases(69.0%)of abdominal pain,163 cases(53.3%)of diarrhea,46 cases(15.0%)of abdominal distension,75 cases(24.5%)of acute weight loss,131 cases(42.8%)of weight loss.There were 44 cases of fever(14.4%)and 3 cases of constipation(1.0%).3.Pathological manifestations:There were 108 cases of chronic mucosal inflammation(35.29%),149 cases of acute and chronic mucosal inflammation(48.69%),44 cases ofneutrophil infiltration(14.38%),138 cases of ulceration(45.10%),21 cases of cryptic inflammation(6.86%),72 cases of crypt abscess(23.53%),15 cases of inflammatory polyp(4.90%).Hyperplastic polyps were found in 15 cases(4.90%).There were 27 cases of low grade intraepithelial neoplasia(8.82%),6 cases of high grade intraepithelial neoplasia(1.96%),5 cases of dysplasia(1.63%),38 cases of adenoma(12.42%),and 12 cases of adenocarcinoma(3.92%).4.Indicators of laboratory examination:70 cases(23.0%)of leukocyte>9.5*109/L,97 cases(32.0%)of anemia,154 cases(52.4%)of albumin<40g/L,91 cases(43.8%)of erythrocyte sedimentation rate>20mm/h,108 cases of elevated C-reactive protein(59.7%),35 cases(39.3%)of elevated precalcitonin.206 cases(67.3%)of anti-nuclear antibody were undetected,15 cases(4.9%)of positive,11 cases(3.6%)of weak positive,74 cases(24.2%)of negative,234 cases(76.5%)of anti-neutrophil perinuclear antibody were undetected,17 cases(5.6%)of positive,55 cases(18.0%)of negative.Anti-neutrophil cytoplasmic antibody was undetected in 234 cases(76.8%),positive in 0 cases,negative in 72 cases(23.2%),undetected in 261 cases(85.3%)of Epstein-Barr virus infection,positive in 23 cases(7.5%),negative in 22 cases(7.2%),and undetected in 256 cases(83.7%)of CMV infection,positive in 3 cases(1.0%).Forty-seven cases(15.4%)were negative.5.Histological inflammatory activity score:The highest HIA score was 0 in 6 cases(2.0%),1 in 61 cases(19.9%),2 in 69 cases(22.5),3 in 2 cases(0.7%),4 in 29 cases(9.5%),and 5 in 139 cases(45.4%).Improved TR score:1 score in 6 cases(2.0%),2 score in 81 cases(26.5%),and 3 score in 219 cases(71.6%).6.Statistical analysis:In univariate analysis,gender,BMI,HB,ESR,abdominal pain,fever,as well as the highest HIA score,mean HIA score and modified TR score were different among patients with UC canceration,precancerous lesion and UC group.In multivariate regression analysis,"cancer and precancerous lesion group" and"UC group" were analyzed and compared,and the highest HIA score,average HIA score and modified TR score increased by 1 unit,the risk of CRC and precancerous lesion in UC patients increased by 2.176-fold respectively(OR=2.176,P<0.000),2.422 times(OR=2.422,P<0.028),4.805 times(OR=4.805,P<0.006).Middle-aged patients had an increased risk of developing colorectal cancer and precancerous lesions compared with younger and older patients.ConclusionIncreased ESR and increased risk of UC-CRC and precancerous lesions in middle-aged patients with UC.An increase of 1 unit in the highest HIA score,mean HIA score,and modified TR score was associated with a 2-4-fold increase in UC-CRC and precancerous lesions in patients with UC.Histological inflammation score,ESR,and age can be used to evaluate the likelihood of UC-CRC in UC to some extent.There is a strong positive correlation between the three kinds of scores.Research SignificanceThrough this study,the relationship between histological inflammatory burden score and UC-CRC was analyzed,and the relationship between histological inflammatory score and laboratory examination,clinical manifestations,colorectal cancer and precancerous lesions of patients was analyzed,so as to evaluate whether histological inflammatory score could provide guidance for disease monitoring in patients with UC with a long course of disease.To evaluate whether colonic mucosal tissue normalization can be used as a clinical endpoint for patients with UC. |
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