PDF(Pubmed)
Abstract：
OBJECTIVE: Few population-based studies have investigated long-term surgery rates for Crohn\'s disease [CD]. Our aim was to analyse disease progression and surgery rates in a population-based cohort over different therapeutic eras, based on the time of diagnosis: cohort-A [1977-1995], cohort-B [1996-2008], and cohort-C [2009-2018].
METHODS: A total of 946 incident CD patients were analysed (male/female: 496/450; median age at diagnosis: 28 years [y]; interquartile range [IQR]: 22-40]). Patient inclusion lasted between 1977 and 2018. Immunomodulators have become widespread in Hungary since the mid-1990s and biologic therapies since 2008. Patients were followed prospectively, with both in-hospital and outpatient records reviewed regularly.
RESULTS: The probability of disease behaviour progression from inflammatory [B1] to stenosing or penetrating phenotype [B2/B3] significantly decreased (27.1 ± 5.3%/21.5 ± 2.5%/11.3 ± 2.2% in cohorts A/B/C, respectively, after 5 years; 44.3 ± 5.9%/30.6 ± 2.8%/16.1 ± 2.9% after 10 years, respectively; [pLogRank <0.001]). The probability of first resective surgery between cohorts A/B/C were 33.3 ± 3.8%/26.5 ± 2.1%/28.1 ± 2.4%, respectively, after 5 years; 46.1 ± 4.1%/32.6 ± 2.2%/33.0 ± 2.7% after 10 years, respectively; and 59.1 ± 4.0%/41.4 ± 2.6% [cohorts A/B] after 20 years. There was a significant decrease in first resective surgery risk between cohorts A and B [plog rank = 0.002]; however, no further decrease between cohorts B and C [plog rank = 0.665]. The cumulative probability of re-resection in cohorts A/B/C was decreasing over time (17.3 ± 4.1%/12.6 ± 2.6%/4.7 ± 2.0%, respectively, after 5 years [plog rank = 0.001]).
CONCLUSIONS: We report a continuous decline in reoperation rates and disease behaviour progression in CD over time, with the lowest values in the biologic era. In contrast, there was no further decrease in the probability of first major resective surgery after the immunosuppressive era.
METHODS: A total of 946 incident CD patients were analysed (male/female: 496/450; median age at diagnosis: 28 years [y]; interquartile range [IQR]: 22-40]). Patient inclusion lasted between 1977 and 2018. Immunomodulators have become widespread in Hungary since the mid-1990s and biologic therapies since 2008. Patients were followed prospectively, with both in-hospital and outpatient records reviewed regularly.
RESULTS: The probability of disease behaviour progression from inflammatory [B1] to stenosing or penetrating phenotype [B2/B3] significantly decreased (27.1 ± 5.3%/21.5 ± 2.5%/11.3 ± 2.2% in cohorts A/B/C, respectively, after 5 years; 44.3 ± 5.9%/30.6 ± 2.8%/16.1 ± 2.9% after 10 years, respectively; [pLogRank <0.001]). The probability of first resective surgery between cohorts A/B/C were 33.3 ± 3.8%/26.5 ± 2.1%/28.1 ± 2.4%, respectively, after 5 years; 46.1 ± 4.1%/32.6 ± 2.2%/33.0 ± 2.7% after 10 years, respectively; and 59.1 ± 4.0%/41.4 ± 2.6% [cohorts A/B] after 20 years. There was a significant decrease in first resective surgery risk between cohorts A and B [plog rank = 0.002]; however, no further decrease between cohorts B and C [plog rank = 0.665]. The cumulative probability of re-resection in cohorts A/B/C was decreasing over time (17.3 ± 4.1%/12.6 ± 2.6%/4.7 ± 2.0%, respectively, after 5 years [plog rank = 0.001]).
CONCLUSIONS: We report a continuous decline in reoperation rates and disease behaviour progression in CD over time, with the lowest values in the biologic era. In contrast, there was no further decrease in the probability of first major resective surgery after the immunosuppressive era.
摘要：
目的：很少有基于人群的研究调查克罗恩病（CD）的长期手术率。我们的目的是根据诊断时间分析不同治疗时代的基于人群的队列中的疾病进展和手术率；队列A（1977-1995），队列B(1996-2008)，和队列C（2009-2018）。
方法：分析946例CD患者（男/女：496/450；诊断时的中位年龄：28岁（y）[IQR：22-40]）。患者纳入持续了1977年至2018年。自1990年代中期以来，免疫调节剂已在匈牙利广泛使用，而自2008年以来的生物疗法。对患者进行了前瞻性随访，定期审查住院和门诊记录。
结果：从炎症（B1）到狭窄或穿透性表型（B2/B3）的疾病行为进展的概率显着降低（27.1±5.3％/21.5±2.5％/11.3±2.2％在5年后，10年后44.3±5.9％/30.6±2.8％/16.1±2.9％；[pLogRank<0.001]）。5年后，A/B/C组首次切除手术的概率为33.3±3.8％/26.5±2.1％/28.1±2.4％；10年后46.1±4.1％/32.6±2.2％/33.0±2.7％；20年后59.1±4.0％/41.4±2.6％（队列A/B）。队列A和B之间的首次切除手术风险显着降低[pLogRank=0.002]，然而，队列B和C之间没有进一步下降[pLogRank=0.665]。队列A/B/C中的再切除的累积概率随着时间的推移而降低(5年后17.3±4.1%/12.6±2.6%/4.7±2.0%[pLog秩=0.001])。
结论：我们报告了随着时间的推移，CD的再手术率和疾病行为进展持续下降，在生物学时代是最低值。相比之下,免疫抑制时代后首次大切除手术的可能性没有进一步降低.
方法：分析946例CD患者（男/女：496/450；诊断时的中位年龄：28岁（y）[IQR：22-40]）。患者纳入持续了1977年至2018年。自1990年代中期以来，免疫调节剂已在匈牙利广泛使用，而自2008年以来的生物疗法。对患者进行了前瞻性随访，定期审查住院和门诊记录。
结果：从炎症（B1）到狭窄或穿透性表型（B2/B3）的疾病行为进展的概率显着降低（27.1±5.3％/21.5±2.5％/11.3±2.2％在5年后，10年后44.3±5.9％/30.6±2.8％/16.1±2.9％；[pLogRank<0.001]）。5年后，A/B/C组首次切除手术的概率为33.3±3.8％/26.5±2.1％/28.1±2.4％；10年后46.1±4.1％/32.6±2.2％/33.0±2.7％；20年后59.1±4.0％/41.4±2.6％（队列A/B）。队列A和B之间的首次切除手术风险显着降低[pLogRank=0.002]，然而，队列B和C之间没有进一步下降[pLogRank=0.665]。队列A/B/C中的再切除的累积概率随着时间的推移而降低(5年后17.3±4.1%/12.6±2.6%/4.7±2.0%[pLog秩=0.001])。
结论：我们报告了随着时间的推移，CD的再手术率和疾病行为进展持续下降，在生物学时代是最低值。相比之下,免疫抑制时代后首次大切除手术的可能性没有进一步降低.
