Inflammatory bowel disease and pancreatic cancer: a Scandinavian register‐based cohort study 1969‐2017

Everhov, Åsa H; Erichsen, Rune; Sachs, Michael; Pedersen, Lars; Halfvarson, Jonas; Askling, Johan; Ekbom, Anders; Ludvigsson, Jonas F.; Sørensen, Henrik Toft; Olén, Ola

doi:10.1111/apt.15785

Cited by 35 publications

(51 citation statements)

References 45 publications

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“…Five-year overall survival in this study was 68% in the surveillance and 20% in the non-surveillance group. A lower probability of cancer related adverse events was also found at five-year follow-up [43] .…”

Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 61%

“…A low intraindividual variability of CA 19-9 over time is reported and the individual levels seem to be affected by genetic differences in the FUT 2/3 genes [56,57] . CA 19-9 was evaluated together with imaging in a surveillance program and was found to be a predictor of mortality and CCA-related adverse events, but 70% of the perihilar CCA in this study had low (< 100 U/mL) or normal CA 19-9 levels [43] . CA 19-9 is therefore an insufficient marker for regular surveillance for early detection of CCA in PSC [52,[55][56][57][58] .…”

Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 64%

“…Longitudinal data from the United States of 830 PSC patients detected 20 (2.4%) patients with HCC during a 9.5-year follow-up, which represented 22% of all hepatobiliary cancers. All HCC cases had late-stage PSC [43] . Judging from this evidence, the increased risk for HCC in PSC concerns only those who have developed cirrhosis.…”

Section: The Risk Of Hepatocellular Cancermentioning

confidence: 99%

“…Guidelines support surveillance, albeit evidence for a concrete surveillance strategy is limited and prospective studies of the cost-benefit are needed [20] . One large retrospective study from the Mayo Clinic has shown that annual surveillance [imaging with ultrasound, MRI, or computer tomography plus cancer associated antigen (CA) 19-9] was associated with a better survival [43] . Patients exposed to surveillance were diagnosed earlier and were available for curative treatment with liver transplantation.…”

Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 99%

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Neoplastic risk for liver and colon in primary sclerosing cholangitis

Båve¹,

Bergquist²

2021

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Primary sclerosing cholangitis (PSC) is a rare disease that may well be notified as a premalignant condition due to the increased cancer risk. The risk is highest for hepatobiliary cancer and increased by 28-398 times compared to the general population. When comorbidity with inflammatory bowel disease exists, the risk for colorectal cancer is increased 5-12 times and may even be higher after liver transplantation. The cancer risk estimates have decreased with time but vary according to study design. More recent population-based studies have approximated lower cancer risk than previous studies. Higher awareness and earlier detection of PSC together with increased surveillance over time may have influenced risk estimates. Surveillance for PSC patients is recommended for early tumor detection in both the liver and colon to enable curative treatment. The evidence for the efficacy of surveillance for early detection of hepatobiliary cancer is weak and an accepted common strategy worldwide is lacking. The high risk of hepatobiliary cancers has been confirmed repeatedly and future studies in PSC should focus on individualizing follow-up strategies and treatment.

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Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 61%

Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 64%

Section: The Risk Of Hepatocellular Cancermentioning

confidence: 99%

Section: Surveillance For Early Detection Of Hepatobiliary Cancermentioning

confidence: 99%

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Neoplastic risk for liver and colon in primary sclerosing cholangitis

Båve¹,

Bergquist²

2021

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“…Previous studies suggested that some disorders, including dyspepsia, gastroesophageal reflux disease, peptic ulcer disease with H. pylori infection, diabetes, cholelithiasis, chronic pancreatitis, inflammatory bowel disease and other gastrointestinal cancers, have the same underlying symptoms and therefore lead to upper gastrointestinal endoscopy and/or biopsy samplings (23,31,32). Some of these disorders have also been reported to associate with an increased risk of pancreatic cancer (22,(33)(34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

Gastric Mucosal Abnormality and Risk of Pancreatic Cancer: A Population-Based Gastric Biopsy Cohort Study in Sweden

Song

Ekheden

et al. 2021

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background:It remains open whether gastric precancerous lesions are associated with an elevated risk of pancreatic cancer. Our aim was to investigate the association between gastric mucosal status and pancreatic cancer risk.Methods: Patients with gastric biopsies (normal, minor changes, superficial gastritis, and atrophic gastritis/intestinal metaplasia/dysplasia [AG/IM/Dys]) from the Swedish histopathology registers during 1979-2011 were included. Cross linkages with several nationwide registries allowed complete follow-up and identification of pancreatic cancer cases until 2014. Standardized incidence ratios (SIRs) and hazard ratios were estimated.Results: During 3,438,248 person-years of follow-up with 318,653 participants, 3,540 cases of pancreatic cancer were identified. The same pattern of excess risk of pancreatic cancer compared to the general population was observed across all groups: a peak of 12-to 21-fold excess risk in the first year after biopsy (e.g., normal: SIR=17.4, 95% CI 15.7-19.3; AG/IM/Dys: SIR=11.5, 95% CI 9.9-13.4) which dropped dramatically during the second and third year, followed by 20%-30% increased risk after the third year (e.g., normal: SIR=1.2, 95% CI 1.1-1.4; AG/IM/Dys: SIR=1.3, 95% CI 1.1-1.5). However, no significant excess risk was observed with the normal gastric mucosa as reference. Conclusions:This unique large pathological cohort study did not find evidence that abnormal gastric mucosal status is causally associated with a long-term pancreatic cancer risk. However, a highly increased short-term risk was observed for people undergoing gastroscopy with biopsy sampling compared with the general population.Impact: Further studies for a long-term risk of pancreatic cancer in patients with gastric biopsies are needed, with further adjustments.Research.

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More vs Less Frequent Follow-Up Testing and 10-Year Mortality in Patients With Stage II or III Colorectal Cancer

Sørensen,

Horváth-Puhó,

Petersen

et al. 2024

JAMA Netw Open

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ImportanceAlthough intensive follow-up of patients after curative surgery for colorectal cancer is common in clinical practice, evidence for a long-term survival benefit of more frequent testing is limited.ObjectiveTo examine overall and colorectal cancer–specific mortality rates in patients with stage II or III colorectal cancer who underwent curative surgery and underwent high-frequency or low-frequency follow-up testing.Design, Setting, and ParticipantsThis randomized clinical trial with posttrial prespecified follow-up was performed in 23 centers in Sweden and Denmark. The original study enrolled 2509 patients with stage II or III colorectal cancer from Sweden, Denmark, and Uruguay (1 center) who received treatment from January 1, 2006, through December 31, 2010, and were followed up for up to 5 years. The participants from Sweden and Denmark were then followed up for 10 years through population-based health registries. The 53 patients from Uruguay were not included in the posttrial follow-up. Statistical analysis was performed from March to June 2024.InterventionsPatients were randomly allocated to follow-up testing with computed tomography (CT) scans and serum carcinoembryonic antigen (CEA) screening at 6, 12, 18, 24, and 36 months after surgery (high-frequency group; 1227 patients), or at 12 and 36 months after surgery (low-frequency group, 1229 patients).Main Outcomes and MeasuresThe outcomes were 10-year overall mortality and colorectal cancer–specific mortality rates. Both intention-to-treat and per-protocol analyses were performed.ResultsOf the 2555 patients who were randomly allocated, 2509 were included in the intention-to-treat analysis, of whom 2456 (97.9%) were included in this posttrial analysis (median age, 65 years [IQR, 59-70 years]; 1355 male patients [55.2%]). The 10-year overall mortality rate for the high-frequency group was 27.1% (333 of 1227; 95% CI, 24.7%-29.7%) compared with 28.4% (349 of 1229; 95% CI, 26.0%-31.0%) in the low-frequency group (risk difference, 1.3% [95% CI, −2.3% to 4.8%]). The 10-year colorectal cancer–specific mortality rate in the high-frequency group was 15.6% (191 of 1227; 95% CI, 13.6%-17.7%) compared with 16.0% (196 of 1229; 95% CI, 14.0%-18.1%) in the low-frequency group (risk difference, 0.4% [95% CI, −2.5% to 3.3%]). The same pattern resulted from the per-protocol analysis.Conclusions and RelevanceAmong patients with stage II or III colorectal cancer, more frequent follow-up testing with CT scans and CEA testing did not result in a significant reduction in 10-year overall mortality or colorectal cancer–specific mortality. The results of this trial should be considered as the evidence base for updating clinical guidelines.Trial RegistrationClinicalTrials.gov Identifier: NCT00225641

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Inflammatory bowel disease and pancreatic cancer: a Scandinavian register‐based cohort study 1969‐2017

Cited by 35 publications

References 45 publications

Neoplastic risk for liver and colon in primary sclerosing cholangitis

Neoplastic risk for liver and colon in primary sclerosing cholangitis

Gastric Mucosal Abnormality and Risk of Pancreatic Cancer: A Population-Based Gastric Biopsy Cohort Study in Sweden

More vs Less Frequent Follow-Up Testing and 10-Year Mortality in Patients With Stage II or III Colorectal Cancer

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