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Lakatos L, Mester G, Erdelyi Z, et al. Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study

1st Department of Medicine, Csolnoky F. County Hospital, Veszprem, Hungary.
Inflammatory Bowel Diseases (Impact Factor: 5.48). 04/2006; 12(3):205-11. DOI: 10.1097/01.MIB.0000217770.21261.ce
Source: PubMed

ABSTRACT There is an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC). The prevalence of UC-associated CRC is different in various geographic regions. The risk depends primarily on the duration and extent of disease. The aim of this study was to identify the risk factors for and the epidemiology of CRC in Hungarian patients with UC.
We retrospectively evaluated the relevant epidemiological and clinical data of all patients with UC in Veszprem province in our 30-year IBD database (723 patients with UC; male/female, 380/343; non-CRC related colectomies, 3.7%).
CRC was diagnosed in 13 patients (13/8564 person-year duration) during follow-up. Age at diagnosis of CRC was at a median of 51 (range 27-70) years. Eight patients are still alive, 4 died of CRC, and 1 died of an unrelated cause. Longer disease duration, extensive colitis, primary sclerosing cholangitis, and dysplasia found in the biopsy specimen were identified as risk factors for developing CRC. The cumulative risk of developing CRC after a disease duration of 10 years was 0.6% (95% confidence interval [CI] 0.2%-1.0%); 20 years, 5.4% (95% CI 3.7%-7.1%); and 30 years, 7.5% (95% CI 4.8%-10.2%). CRC diagnosed at surveillance colonoscopy was associated with a tendency for longer survival (P = 0.08).
The cumulative risk of CRC was high in our patients with UC; however, it was lower compared with that reported in Western European and North American studies. CRC developed approximately 15 years earlier compared with sporadic CRC patients in Hungary. Longer disease duration, extensive colitis, dysplasia, and primary sclerosing cholangitis were identified as important risk factors for developing CRC.

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    • "The important risk factors include family history of colon cancer, disease duration/extent, and concurrent primary biliary cholangitis [3] [4]. The cancer risk seems to be closely associated with the extent of colonic involvement and length of time since disease onset [5]. To detect microscopic foci of dysplasia or early stage of cancer, IBD patients need to undergo an annual colonoscopy with multiple biopsies. "
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    • "In Asia-Pacific, however, the incidence of CAC is relatively low but showing a steadily increase (Yang et al., 2000; Chow et al., 2009; Kim et al., 2009; Ooi et al., 2010). Nonetheless, in some regions, no increase or even a decrease in the incidence of CAC was observed (Winther et al., 2004; Jess et al., 2006; Lakatos et al., 2006). Some other studies have confirmed an increased risk of CAC in different countries, but the exact magnitude varies substantially (Ahmadi et al., 2009). "
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    • "The cumulative probability of CRC development after 30 years was 2%, not significantly different from the risk of the background population [Jess et al. 2006]. Slightly higher risk estimates were found in a study from Hungary with the cumulative risk of CRC was 0.6% after 10 years, 5.4% after 20 years and 7.5% after 30 years of UC [Lakatos et al. 2006]. In a referral-based study from UK, the cumulative incidence of CRC was 2.5% after 20 years, 7.6% after 30 years and 10.8% after 40 years [Rutter et al. 2006]. "
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