Nancy Index Scores of Chronic Inflammatory Bowel Disease Activity Associate With Development of Colorectal Neoplasia

Kirchgesner, Julien; Svrcek, Magali; Gall, Guillaume Le; Landman, Cécilia; Dray, Xavier; Bourrier, Anne; Nion–Larmurier, Isabelle; Hoyeau, Nadia; Sokol, Harry; Seksik, Philippe; Cosnes, Jacques; Fléjou, Jean‐François; Beaugerie, Laurent

doi:10.1016/j.cgh.2019.05.002

Cited by 28 publications

(24 citation statements)

References 24 publications

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“…[4][5][6] It is estimated that young adults with pancolitis have a lifetime risk of colorectal cancer that exceeds 15%. 4 Since the excess of risk is related to colonic chronic inflammation, 7 UC treatments, by decreasing colonic inflammation, may decrease the risk of colorectal cancer. While several population based cohort studies and meta-analyses of observational studies assessed the impact of aminosalicylates and thiopurines on the risk of colorectal cancer, 1,[8][9][10][11] no population-based cohort study specifically assessed the impact of anti-TNF on this risk.…”

Section: Introductionmentioning

confidence: 99%

Impact of Anti-tumour Necrosis Factor Agents on the Risk of Colorectal Cancer in Patients with Ulcerative Colitis: Nationwide French Cohort Study

Charkaoui

Hajage

Tubach

et al. 2021

Journal of Crohn's and Colitis

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Background and Aims Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer. Anti-tumor necrosis factor agents (anti-TNF) aim to reduce chronic colonic inflammation and may lower the risk of colorectal cancer (CRC), but the impact of anti-TNF exposure has not yet been assessed in population-based cohort studies. The aim of this nationwide study was to assess the risk of CRC in patients with UC exposed to anti-TNF. Methods Based on the French health insurance database, patients aged 18 years or older with a diagnosis of UC, previously exposed to or initiating immunosuppressive treatment were followed from 1 January 2009 until 31 December 2018. The risk of CRC associated with anti-TNF exposure was assessed using marginal structural Cox proportional hazard models adjusting for baseline and time-varying comorbidities including primary sclerosing cholangitis, UC disease activity, colonoscopic surveillance, and other medications. Results Among 32,403 patients with UC, 15,542 (48.0%) were exposed to anti-TNF. During a median follow-up of 6.1 years (198,249 person-years), 246 incident CRC occurred (incidence rate per 1000 person-years, 1.24; 95% CI, 1.10-1.41). While the risk of CRC associated with anti-TNF exposure was not decreased in the overall group of patients with UC (HR, 0.85; 95% CI, 0.58-1.26), anti-TNF exposure was associated with a decreased risk of CRC in patients with long- standing colitis (disease duration ≥ 10 years) (HR, 0.41; 95% CI, 0.20-0.86). Conclusions In a nationwide cohort of patients with UC, anti-TNF exposure was associated with a decreased risk of CRC in patients with long-standing colitis.

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Section: Introductionmentioning

confidence: 99%

Impact of Anti-tumour Necrosis Factor Agents on the Risk of Colorectal Cancer in Patients with Ulcerative Colitis: Nationwide French Cohort Study

Charkaoui

Hajage

Tubach

et al. 2021

Journal of Crohn's and Colitis

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“…A recent study assessed the role of histologic activity in neoplasia development in a cohort of 398 IBD patients, of which 237 had CD. 30 Histologic activity was strongly associated with the risk of neoplasia development in this cohort. These results indicate that histologic activity increases the risk of colorectal neoplasia in both UC and CD.…”

Section: Histologic Activity Measurements In Assessing Risk Of Colore...mentioning

confidence: 68%

Measuring Histologic Activity in Inflammatory Bowel Disease: Why and How

Pai

Lauwers

Pai

2021

Advances in Anatomic Pathology

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Histology is used to confirm the diagnosis of inflammatory bowel disease, exclude superimposed infections, and to evaluate for dysplasia. Histology has rarely been used to measure disease activity and guide therapy despite evidence that histologic measurements have value in predicting important clinical outcomes. More recently, there have been numerous studies supporting a role for histologic disease activity measurements in predicting a variety of outcomes including relapse, hospitalizations, steroid use, and dysplasia. The histologic assessment was superior to endoscopic measurements in many of these studies. This review will summarize the recent literature regarding histologic disease activity measurements in ulcerative colitis and Crohn disease. A detailed description of histologic scoring systems will also be provided to provide pathologists with the necessary tools to accurately measure disease activity.

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“…assessed by NI was associated with an increased risk of colorectal neoplasia (per 1-unit increase, OR, 1.69; 95% CI, 1.29-2.21) [50].…”

Section: Histologic Healing In Ibd: Towards Disease Clearance?mentioning

confidence: 95%

“…Data also suggest that finer microscopic control of inflammation can prevent epithelial dysplastic modifications and carcinogenesis in both UC and CD [48,49]. Recently, Kirchgesner et al performed a case-control study including 45 patients with neoplasia (dysplasia/adenocarcinoma, 20 CD and 25 UC) and 353 controls: histological activity as assessed by NI was associated with an increased risk of colorectal neoplasia (per 1-unit increase, OR, 1.69; 95% CI, 1.29-2.21) [50].…”

Section: Histologic Healing In Ibd: Towards Disease Clearance?mentioning

confidence: 99%

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

D’Amico

Sollai

Allocca

et al. 2022

JCM

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The histological assessment has been advocated as a detailed and accurate measure of disease activity in inflammatory bowel diseases (IBD). In ulcerative colitis (UC), histological activity has been demonstrated to be associated with higher rates of relapse, prolonged corticosteroid use and long-term complications, even when endoscopic remission is achieved. Therefore, histological healing may represent a potential treatment target. Several histological scores have been developed and are available today. The Robarts histopathology index (RHI) and the Nancy index (NI) are the only two recommended by the European Crohn’s and Colitis Organization (ECCO) for use in patients with UC. Conversely, in Crohn’s disease (CD), the discontinuous nature of lesions has limited standardized histological assessment. Most of the available histological scoring systems in CD are complex and not validated. The aim of this review is to comprehensively summarize the latest evidence regarding histological scoring systems in IBD. We guide the reader through understanding the importance of an accurate microscopic evaluation using validated scoring systems, highlighting the strengths and pitfalls of each score. The priorities of future research needs are also addressed.

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Nancy Index Scores of Chronic Inflammatory Bowel Disease Activity Associate With Development of Colorectal Neoplasia

Cited by 28 publications

References 24 publications

Impact of Anti-tumour Necrosis Factor Agents on the Risk of Colorectal Cancer in Patients with Ulcerative Colitis: Nationwide French Cohort Study

Impact of Anti-tumour Necrosis Factor Agents on the Risk of Colorectal Cancer in Patients with Ulcerative Colitis: Nationwide French Cohort Study

Measuring Histologic Activity in Inflammatory Bowel Disease: Why and How

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

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