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Impact of Inflammatory Bowel Disease and Primary Sclerosing Cholangitis on Colorectal Cancer Risk: National Cohort
Maie Abdalla1, Michael Eberhardson2, Kalle Landerholm3
1Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Surgery, Capio Specialist Health Care, Motala, Sweden.
Background & Aims:
Inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC). Previous studies concluded that primary sclerosing cholangitis (PSC) is an independent risk factor for CRC in IBD. We aimed to investigate the impact of IBD and PSC on the risk of developing CRC, mortality, and colectomy.
Methods:
Patients with IBD diagnosed between 1969 and 2014 were identified from the Swedish National Patient Register, together with 5 matched controls per case from the background population. We estimated the impact of some risk factors including PSC± on the risk of CRC and mortality in the patients with IBD compared with that in the controls, and colectomy within the IBD cohort.
Results:
Among all patients with IBD, the hazard ratio (HR) of CRC was 1.83 (95% confidence interval [CI], 1.72-1.96; P < .001). The risk was highest in the PSC+ patients initially but decreased over time. PSC+ patients diagnosed with IBD ≤20 years of age had a highly increased risk with an incidence rate ratio (IRR) of 74.97 (95% CI, 44.7-126.1; P < .001) compared with controls. PSC+ patients had 9 to 16 times higher risk of cancer in cecum/ascending, transverse, and descending colon compared with sporadic CRC among controls. Synchronous cancer was found in 4.7% of PSC+ patients, 4.4% of PSC- patients, and 1.9% among controls (P < .001).
Conclusions:
Patients with IBD have an increased risk of CRC, mostly prominent among young PSC+ patients. PSC+ patients display a tendency to develop CRC in the proximal colon and more synchronous CRC. This should be considered when monitoring and counseling patients with IBD.
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