Intest Res > Volume 14(3); 2016 > Article |
|
Quality assessment scale | Accepted criteria | Rutter et al. (2004)1 | Rubin et al. (2013)4 |
---|---|---|---|
Selection | |||
1. Is the case definition adequate? | Independent validation; Record linkage | - | - |
2. Representativeness of the cases |
Representative of average UC Sex, age and disease severity |
- | * |
3. Selection of controls | Population from similar setting | * | * |
4. Definition of controls | No history of neoplasia | * | * |
Comparability | |||
Comparability of cases and controls on basis of the design and follow-up | Cases and controls were adequately matched | * | * |
Exposure | |||
Ascertainment of exposure | Secure histology records | - | - |
Same method of ascertainment for cases and controls | Same histological scores between cases-controls | * | * |
Total | (max=8) | 4 | 5 |
Quality assessment scale | Accepted criteria | Gupta et al. (2007)2 | Korelitz et al. (2014)3 |
---|---|---|---|
Selection | |||
Representativeness of the exposed cohort |
Representative of average UC Sex, age and disease severity |
- | - |
Representativeness of the non-exposed cohort | Drawn from the same community as exposed cohort | * | * |
Ascertainment of exposure | Secure records | * | - |
Demonstration that outcome of interest was not present at start of study | No neoplasia (or history of neoplasia) on first colonoscopy | * | - |
Comparability | |||
Comparability of cohorts on the basis | Match between design and confounders of cases-controls | - | - |
Outcome | |||
Follow-up long enough for outcome to occur? | Assessment of outcome | - | * |
Adequacy of follow up of cohorts | Follow-up of complete cohort or unlikely to introduce bias? | * | * |
Total | (max=8) | 4 | 3 |
Study | Study type | Dx | Aims | Inclusion | Specific exclusion mentioned | No. of patients | Histology measures | Other factors |
---|---|---|---|---|---|---|---|---|
Rutter et al. (2004)1 | Case-control | UC | Examine risk factors for colorectal neoplasia |
All Neoplasia cases Controls with intact colons and matched for a variety of factors Matched by age, sex, and age at symptom onset and UC duration and year of index scope (to match time eras) |
Neoplasia cases: 68 Matched-controls: 136 |
Simple histologic index (0-4): Mean scores per scope Mean scores overall |
PSC Smoking history Family history of CRC Mesalamine use Azathioprine use Folate supplements |
|
Gupta et al. (2007)2 | Cohort | UC | To determine whether severity of microscopic inflammation over time is an independent risk factor for neoplastic progression in UC |
Prior colonoscopy UC ≥7 years No prior dysplasia or CRC At least 1 F/U colonoscopy |
Prior colorectal surgery CD Indeterminate colitis |
Total cohort: 418 15 progressed to HGD/CRC 65 to any neoplasia |
Histologic activity index (0-3): IS-mean (average inflammation score over time) IS-bin (binary inflammation score) 1 if IS-mean ≥1 IS-max (maximum inflammation score over time) |
No. of colonoscopies Extent, duration of disease age at diagnosis PSC Medication exposure (5-ASA, thiopurines, steroids, cyclosporine, folate Male sex |
Rubin et al. (2013)4 | Case-control | UC | To evaluate CRN in UC by degree of inflammation over time |
Colon Matched by: extent, age at dx, and duration of dx (matched 1-4 individuals) |
Neoplasia proximal to colon Prior colorectal surgery |
Neoplasia cases: 59 Matched-controls: 141 |
Histological inflammatory activity ( scores 0-5): Mean score for all procedures combined Maximum score for single biopsy |
Smoking Family history of CRC PSC Use of 5-ASA, IMMs, steroid, folate, NSAIDs |
Korelitz et al. (2014)3 | Cohort | UC | To evaluate if histologic inflammation in absence of endoscopic inflammation leads to an increased advanced CRN risk |
UC ≥20 years ≥3 scopes+biopsies, 10 years after diagnosis |
Total cohort: 68 20 progressed to HGD/ CRC 48 did not develop advanced neoplasia |
No specific histologic activity index reported No mean or maximum scores calculated |
NA |
Outcomes only reported for significant values, unless no outcome was significant for a specific neoplasia outcome.
aHazard ratio of IS-mean (For 1-unit increase the cumulative mean histologic inflammation score, there was a X fold increase for neoplasia).
bOdds ratio of colorectal neoplasia if 1-unit increase in histological score.
cSame effect size and significance, for both univariate and multivariate model, because histologic inflammation was the only variable in model.
dAdvanced neoplasia: high-grade dysplasia and cancer.
eBinary inflammation score: 1 if IS-mean ≥1.
fMaximum inflammation score over time.
gControlled for 1 or more colonoscopies per year.
HR, hazard ratio; CRC, colorectal cancer.
Study | Neoplasia categories | Analysis type | Cases, mean (SD) | Controls, mean (SD) | OR or HRa (95% CI) | P-value |
---|---|---|---|---|---|---|
Rutter et al. (2004)1 | Any neoplasia | Univariate | 2.38 (0.56) (n=68) | 2.05 (0.41) (n=136) | 5.13 (2.36-11.14)b | <0.001 |
Multivariate | - | - | 4.69 (2.10-10.48)b | <0.001 | ||
CRC only | Univariate and multivariatec | 2.09 (0.44) | 2.54 (0.60) | 6.33 (1.24-32.33) | 0.030 | |
Gupta et al. (2007)2 | Any neoplasia | Univariate | (n=65) | (n=353) | 1.4 (0.90-2.30)a | NS |
Advanced neoplasiad | Univariate | (n=15) | (n=403) |
IS-meana: 3.0 (1.40-6.30) |
<0.050 | |
IS-bine: 3.4 (1.10-10.40) |
||||||
IS-maxf: 2.2 (1.20-4.20) |
||||||
Multivariate | (n=15) | (n=403) |
IS-meana: 3.8 (1.70-8.60) 5.4 (1.70-17.00)g |
<0.050 | ||
Rubin et al. (2013)4 | Any neoplasia | Univariate | 2.00 (0.89) (n=32) | 1.55 (0.68) (n=139) |
Mean-score: 2.56 (1.45-4.54) |
0.001 |
Any neoplasia |
Maximum-score: 1.41 (1.03-1.91) |
0.030 | ||||
Multivariate | - | - |
Mean-score: 3.68 (1.69-7.98) |
0.001 | ||
Dysplasia | Univariate | 2.07 (0.97) (n=44) | 1.52 (0.71) (n=104) | 2.54 (1.35-4.78) | 0.004 | |
Cancer | Univariate | 1.79 (0.51) (n=15) | 1.62 (0.60) (n=37) | 2.64 (0.69-10.2) | NS |
Numerical score | Rutter et al. (2004)1 | Gupta et al. (2007)2 | Rubin et al. (2013)4 |
---|---|---|---|
0 |
Normal No inflammatory cells |
Inactive/quiescent/normal No epithelial infiltration of <50% of sampled crypts or cross sections, no ulcers or erosions |
Normal (completely, uninvolved , no architectural distortion, no infiltrates) |
1 | Chronic inflammation only |
Mildly active Neutrophil infiltration <50% of sampled crypts or cross sections, no ulcers or erosions |
Quiescent (architectural distortion, increased lamina propria lymphs, but no activity) |
2 | Mild active (crypts, but no crypt abscesses) |
Moderately active Neutrophil infiltration ≥50% of sampled crypts or cross sections, no ulcers or erosions |
Increased lamina propria granulocytes without definite interepithelial granulocytes |
3 | Moderate active (few crypt abscesses) |
Severely active Erosion or ulceration, irrespective of other features |
Intraepithelial granulcytes (e.g., cryptitis) without crypt abscesses |
4 | Severe active inflammation (numerous crypt abscesses) | - | Crypt abscesses in less than 50% of crypts |
5 | - | - | Crypt abscesses in greater than 50% of crypts, or erosion/ulceration |