Long‐term incidence of dysplasia and colorectal cancer in an ulcerative colitis population‐based cohort

Abstract

Background: Ulcerative colitis (UC) is a risk factor in developing colorectal cancer (CRC). Surveillance programmes aim to identify premalignant lesions to facilitate improved treatment outcomes. Recent studies have suggested that the risk of CRC in UC has decreased. This study aims to characterize the risk of CRC in UC in a population-based New Zealand cohort. Methods: All patients in the Canterbury Inflammatory Bowel Disease Study, a comprehensive population-based cohort, were reviewed and cases of dysplasia and CRC identified. Demographic data and risk factors were assessed and standardized incidence ratios (SIRs) calculated comparing with the national population. Results: A total of 518 UC cases were analysed (46.3% female). Median follow-up was 17.5 years (interquartile range 12.2-25.1 years). Neoplasia developed in 42 (8.1%) patients, 14 (2.7%) of whom had CRC. The mean age at CRC diagnosis was 63.3 years, and mean duration with UC before CRC 18.4 years (0-36.8 years). The total incidence rate was 1.35/1000 person-year duration (95% confidence interval 0.74-2.27). The age-adjusted SIR was 1.74 (95% confidence interval 1.03-2.93) compared to the New Zealand population. Risk factors for any dysplasia included disease extent and male gender. Conclusion: In this population-based cohort with long-term follow-up, the SIR of CRC in UC patients was significantly lower than the initial epidemiological studies although similar to more recent studies. This increased risk still justifies ongoing screening in the UC population.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 821-825ANZJSurg.com

Inflammatory Bowel Disease and Colorectal Cancer

“…4 Other studies have shown a standardized incidence ratio (SIR) of around 1.8, increasing to between 3 and 4 with extensive disease. 4 16 17 In CD, the risk is appreciable only if the colonic phenotype is considered as opposed to the non-colonic phenotypes. In this subgroup, the risk is comparable to the UC population with an SIR over 4 in some studies.…”

IL-8 and LYPD8 expression levels are associated with the inflammatory response in the colon of patients with ulcerative colitis

“…The incidence of colorectal cancer is increasing, and UC is a risk factor of colorectal cancer (2,3). Despite advances in therapeutic options, in a cohort study conducted in New Zealand between 2005 and 2015, 2.7% of all patients with UC went onto develop colorectal cancer (4). UC has a marked negative impact on the quality of life of the patients.…”