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: 4.46). 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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Available from: Simon Fischer, Jul 17, 2014
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    • "A meta-analysis of 116 studies found the mean age of UC-CRC diagnosis to be 43.2 years.[3] Lakatos and coworkers[4] found the average age of IBD-CRC diagnosis to be 10-15 years younger than sporadic CRC in Eastern Europe (50.9 years vs. 62.2 years). The prognosis for sporadic CRC and IBD-CRC is similar, with a 5-year survival of approximately 50%.[5] "
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    ABSTRACT: Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new biomarkers, predicting future occurrence of colonic neoplasia may lead to more biomarker-based surveillance. There are promising results that may lead to more efficient surveillance in IBD patients and more general acceptance of its use. A multidisciplinary approach, involving in particular endoscopists and pathologists, together with a centralized patient management, could help to optimize treatments and follow-up measures, both of which could help to reduce the IBD-associated cancer risk.
    Saudi Journal of Gastroenterology 03/2014; 20(1):26-38. DOI:10.4103/1319-3767.126314 · 1.12 Impact Factor
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    • "Four of the cohort studies calculated incidence rate as the measure of hazard ratio (HRs) [25,29,30,32] and one presented rate ratio (RR)[31]. In terms of geographical settings of the studies, 8 studies were conducted in the Unites States[18,20,22-24,29-31], 9 in Europe[16,17,19,21,25,26,28,31,33], one in New Zealand[27] and one in South Africa[34]. Two studies (Connell [26] & Rutter [21]) were from the same center (St’ Mark Hospital) but the overlap period was short (3 years), both studies were enrolled for analysis. "
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    ABSTRACT: Inflammatory bowel disease (IBD) is commonly treated with thiopurines such as azathioprine and mercaptopurine for the maintenance of remission. Studies examining chemopreventive of these medications on colorectal neoplasm in IBD patients have yielded conflicting results. We performed a meta-analysis to assess the role of thiopurines for this indication. We performed a systematic search of PubMed, Web of Science, EMBASE and Cochrane to identify studies reporting colorectal neoplasm from IBD patients treated with thiopurines and conducted a meta-analysis of pooled relative risk (RR) using the random effects model. Nine case-control and ten cohort studies fulfilled the inclusion criteria. The use of thiopurines was associated with a statistically significant decreased incidence of colorectal neoplasm (summary RR=0.71, 95% CI=0.54-0.94, p=0.017), even after adjustment for duration and extent of the disease, but there was high heterogeneity among studies (I (2)=68.0%, p<0.001). The RR of advanced neoplasm (high-grade dysplasia and cancer) was 0.72 (95%CI=0.50-1.03, p=0.070) and that of cancer was 0.70 (95% CI=0.46-1.09, p=0.111) for thiopurine-treated patients. Heterogeneity of the studies was affected by the sample size (</≥100 cases) and whether the patients had longstanding colitis (≥7 years). The current meta-analysis revealed that thiopurines had a chemopreventive effect of colorectal neoplasms and a tendency of reducing advanced colorectal neoplasms in IBD. Due to the heterogeneity of included studies, these results should be interpreted with caution.
    PLoS ONE 11/2013; 8(11):e81487. DOI:10.1371/journal.pone.0081487 · 3.23 Impact Factor
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    • "With respect to the long-term risk, Winther et al found a cumulative probability of 2.1% at 30 years [5], Jess et al a cumulative incidence of 2% at 25 years [6], and in the study by Lakatos et al 7.5% after 30 years [7]. "
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    ABSTRACT: Inflammatory bowel diseases (IBD) are associated to an increased risk of colorectal cancer, which is primarily related to long-standing chronic inflammation. Recognized risk factors are the duration and extent of the disease, severe endoscopic and histological inflammation, primary sclerosing cholangitis, family history of colorectal cancer and in some studies young age at diagnosis. Recent population-based studies have shown that the risk is lower than previously described or even similar to that of the general population, and this could be justified by methodological aspects (hospital-based vs. population-based studies) or by a true decrease in the risk related to a better control of the disease, the use of drugs with chemoprotective effect or the spread of endoscopic surveillance in high-risk patients. Apart from colorectal cancer, patients with IBD are prone to other intestinal neoplasms (lymphoma, small bowel adenocarcinoma, pouch neoplasia and perianal neoplasia). In this article, the magnitude of the risk of intestinal cancer, the risk factors, the natural history of dysplasia and the recommendations of screening and surveillance in IBD are reviewed.
    Annals of Gastroenterology 03/2012; 25(3):193-200.
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